Stop Breathing in Surgical Smoke

Staff Safety

By: Joe Paone

Published: 6/11/2020

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Joint national grassroots efforts to keep pushing for evacuation in every OR.


Awareness continues to develop around the negative health effects of surgical smoke, which contains harmful chemicals, carcinogens, bacteria and viruses. Spending a full day working smoke-producing cases is said to be equivalent to inhaling more than a full pack of cigarettes. Still, many surgical teams throughout the country operate in ORs without smoke evacuation.

Two simultaneous efforts are well underway to make smoke evacuation mandatory in ORs across the country that collectively employ a carrot-and-stick approach. Nurses and other clinicians at facilities and health systems have launched grassroots efforts to evangelize, educate and win organizational support for smoke evacuation. Meanwhile, in the interest of leveling the playing field, nurses and other stakeholders are working to pass local laws and regulations that ensure the use of smoke evacuation systems.

Working the inside

Andrea Dyer, MSN, RN, an OR travel nurse currently based at Boston Children's Hospital, has made it her mission to advocate for smoke evacuation systems within her own institutions and with legislators. Like many surgical professionals, she once had no idea about the harm in which she was placing herself in every day.

Then she temporarily shifted away from working in the OR. "My asthma got better, my skin rashes went away," she remembers. "I'd think about my best friends in the OR, still breathing in smoke, and was even more motivated to push for mandatory evacuation."

Ms. Dyer interacts whenever she can with legislators; for example, she worked closely with the Association of periOperative Registered Nurses (AORN) on advancing legislation in Oregon before she moved back east. For Ms. Dyer, it's about getting the right message in front of the right people, because there are still large knowledge gaps among public officials, healthcare executives and many clinicians. She's determined to spread the word to all of them.

If you're looking to become a smoke evacuation champion, it's important to establish credibility with newcomers around the concept. "I start with education and awareness," says Ms. Dyer. "I build a rapport first, personally relate to people. Then I explain that there are more than 150 chemicals in surgical smoke, and it's worse than cigarettes because we're filtering live viruses such as hepatitis in our lungs.'"

HOOK IT UP Numerous facilities have smoke evacuation systems in place that aren't used.

Ms. Dyer has needed to recalibrate the thoughts of clinicians who had negative impressions of smoke evacuation systems years ago. She tells them newer streamlined devices are quieter and less obtrusive than previous models. In general, says Ms. Dyer, overcoming cultural norms that are often subject to inertia is a challenge. "Change is really hard," she adds. "The biggest thing with the surgeons is that they aren't exposed like we are, so they aren't seeing the effects we are. I'm encouraged that the younger generation of surgeons want to be protected."

Even facility leaders who understand the risks posed by surgical plume might decide they can't afford to evacuate it, or that it might be too difficult to integrate evacuation into the OR workflow.

Ms. Dyer says cost should not be an issue for facilities, as the machines are usually under $2,000 and are often provided free on consignment by vendors looking to make money off the accompanying single-use pens.

In addition to being an influencer within her organization, Ms. Dyer leverages the digital world to spread the message and connect with likeminded clinicians and important points of contact. "My biggest focus is PR and marketing, getting the word out there," says Ms. Dyer. "I'm adding people on LinkedIn and Facebook who I think will listen, and it's working. I'm constantly posting about it." In many cases, Ms. Dyer has turned those virtual connections into face-to-face meetings.

She says accessible data is vital to getting smoke evacuation systems purchased, installed and used. "You need to know how to sell it to a surgeon. Eighty percent of surgeons will do it because it's the right thing to do, but there will always be naysayers. That's why we need legislation: We're not going to get the voluntary compliance we want. Even when it's in hospital policy, [some surgeons] are not doing it, and it's not fair [to surgical team members]."

AT A GLANCE
Nationwide Lobbying Efforts Paying Off
Looking to get involved in your state?
Visit www.aorn.org/government-affairs

AORN, state associations and individuals have been working steadfastly with state legislatures around the country to ensure the use of smoke evacuation systems in ORs. It's been a long slog, but the massive effort is paying dividends. Here's a snapshot of the current status of legislation around the country, as provided by AORN Senior Director of Government Affairs Jennifer Pennock.

Ms. Pennock says the COVID-19 crisis impacted AORN's surgical smoke legislative efforts this year. "Across the country, state legislatures adjourned, suspended or postponed their 2020 legislative sessions and turned their focus to COVID-19 relief," she says. "In particular, we ran out of time to advance legislation in Connecticut and Georgia. Additionally, interim sessions in Tennessee and Utah may not address the respective surgical smoke bills until later this year."

— Joe Paone

Oregon
An effort to reintroduce a 2019 bill this year as HB 4064 was unable to get a committee hearing. Oregon's 2020 legislative session was a very short 45 days with quick turnaround and tight timelines for all legislative priorities. The legislature directed stakeholders to work on education and awareness of the hazards of surgical smoke in 2020.

California
Cal/OSHA is accepting comments on proposed regulations.

Utah
AORN and local nurse advocates testified in support of SB 105 in February, but the committee did not take a vote. The legislation has moved to the upcoming interim session in the fall for further study.

Colorado
A bill was signed into law in March 2019. It goes into effect in May 2021.

Iowa
HSB 510 was introduced in the State Government Committee, but the legislation did not move out of committee during the 2020 session. AORN and stakeholders agreed to meet this summer to discuss a bill for 2021.

Illinois
SB 3753 was introduced in February, but the bill didn't make it out of committee before the deadline. The legislative session was also interrupted by the pandemic.

Tennessee
A bill was forwarded for further study to the interim summer session, scheduled to convene June 1. That session is expected to focus on COVID-19 before taking up other interim legislation this fall.

Kentucky
The Senate passed SB 91 unanimously in February. It was sent to the Kentucky House Health and Family Services Committee, but not brought up for a hearing. before the legislature adjourned.

Georgia
SB 347 was introduced and heard in the Georgia Senate Health and Human Services Committee in March. AORN worked with the Georgia Nurses Association to support grassroots efforts to advance the legislation. The bill did not get moved to a summer study session before the legislature suspended its session in response to the pandemic.

New Jersey
AB 3982 was ready to be introduced when the General Assembly temporarily suspended its 2020 session due to COVID-19. Now reconvened, the bill has been introduced. However, COVID-19 relief and the state budget have put it on the back burner.

Connecticut
HB 5421 was introduced by the Public Health Committee in March. Scheduled and then re-scheduled for a hearing, it didn't advance because the General Assembly suspended its session shortly after due to COVID-19.

Rhode Island
Law went into effect January 2019.

 

Legislative action

AORN has long been all-in on surgical smoke evacuation. Years ago, it launched an educational program focused on the dangers of surgical smoke. At the time, awareness of the issue was rather low; AORN found a surprising number of its members had never been educated on the topic. As AORN built that awareness among surgical teams, its efforts also moved into statehouses. The organization has coordinated with and energized its state chapters to advance smoke evacuation legislation in specific U.S. states.

The progress of bills and regulations that require use of surgical smoke evacuation systems has been slowed by the COVID-19 pandemic, which has disrupted the activities of state legislatures nationwide. Still, as the middle of 2020 approaches, significant inroads have been made in a number of states. If you're considering the legislative route, reach out to AORN to find out how to get involved most effectively, says Jennifer Pennock, senior manager of government affairs at AORN. "We have a lot of resources available and some steps people can take to lay the groundwork," she says.

AORN might have already done some heavy lifting in your state and might already have people working on the ground with whom you can connect. It also knows the ropes about how to get things accomplished in often bewildering government environments. "You need to work with the right people in each legislative office," says Ms. Pennock. "People go out with good hearts and great enthusiasm, but it takes a lot of knowledge, understanding and experience to work within the system."

AORN has teamed with state nursing associations, clinicians and other stakeholders to engage and educate legislators. As of May 2020, the effort has now borne fruit in 12 U.S. states, with two of those already passing laws, according to Ms. Pennock (see "Nationwide Lobbying Efforts Paying Off).

Making the right people aware of surgical smoke can open eyes and lead to action, because most laypeople have no idea it's an issue and usually are surprised to learn of it. "In Tennessee, a state senator came to the exhibit hall at 2019 AORN Expo, saw a demonstration on surgical smoke, and was really moved by it," says Ms. Pennock. "She wanted to sponsor legislation — and she's in leadership. You've got to run with those opportunities." OSM