A silent health threat lurks in operating rooms across the nation. Doctors and nurses are exposed daily to what's known as surgical smoke.
Surgeon Kevin Hughes in Charleston says the smoke is created as he cuts into tissue using an electrical device he holds like a pen. The device, called a Bovie, has a metal tip that smolders as it burns the skin.
“You can see the smoke initially when you’re doing this,” says Dr. Hughes. “You’re essentially cooking tissue.”
Surgical smoke
That cooking cauterizes, or stops the bleeding, which is good for patients. But the smoke from burning tissue can make Dr. Hughes very sick.
“It feels like bronchitis,” he says. “Yeah, very congested, a little hard to breathe at times and it used to hang on for two to three days when I did get it.”
The veteran surgeon says he stopped getting sick after he began using a Bovie that evacuates smoke through a small vent. He says working without one is like, “sitting in a room with a bunch of smokers.”
Operating nurse Maxine Warner has never smoked. Yet all three of her children had low birth weights. It’s a condition often associated with smoking during pregnancy.
Warner says doctors were so concerned that they analyzed the placenta from one of her pregnancies in 2017. She says the pathology report showed it was very small, below the 10th percentile.
“So, I though it must have been from exposure to work,” says Warner.
The 35-year-old worries, not only about her own health, but the health of her co-workers.
“Because you can tell people have congestion all the time at work,” says Warner. “Like they’re always sick with some sort of respiratory thing.”
Toxic chemicals
Federal health organizations have known for decades that surgical smoke is dangerous for healthcare professionals. They’ve identified at least 80 toxic chemicals, including those that cause cancers and genetic mutations.
The smoke can also contain biological matter like bacteria and viruses. And the particles are so small, they can seep through a surgical mask.
The Centers for Disease Control and Prevention estimates that more than 500,000 health professionals are exposed every year. Yet, there is no federal law requiring smoke evacuation in operating rooms.
Surgical nurse and attorney Kim Tuemler says she did not learn about the dangers until she attended a conference three years ago.
“I was angry. I was very angry,” says Tuemler. “When I was in nursing school, I had breast cancer. And I don’t want anybody else to have cancer, especially not people I work with.”
Tuemler says she now refuses to work in any operating room that does not evacuate surgical smoke. But for many of her colleagues, that’s not an option.
“That’s their health insurance,” says Tuemler. “That pays their mortgage and they’re scared. They don’t want to talk against their hospital.”
Tuemler says it’s repeated exposure that puts doctors and nurses at risk. Patients, she says, are typically intubated. She worries, however, about newborns delivered by C-section. Surgical smoke, she says, could be their first breath.
“It literally comes down to doing the right thing, and taking the time to do the right thing,” she says.
Push for legislation
Tuemler has been pushing for a state law that requires smoke evacuation in operating rooms. Right now, the decision is left up to individual doctors and hospitals.
Some doctors, Tuemler says, seem less inclined to use Bovie’s with smoke evacuating vents. She says they can take some getting used to. But she points out, they are cost effective.
As for hospitals, several across the state do have policies regarding smoke evacuation. They include the Medical University of South Carolina where Dr. Hughes works.
The bill Tuemler helped champion last year did pass the Senate, but it did not get through the House.
State Sen. Greg Hembree (R, Horry) sponsored the measure and says he’s not giving up. He plans to pre-file the bill this year.
“Sometimes it takes three or four or five years, but if you stay with it and it's really a good idea, then it usually gets through,” says Sen. Hembree.
Twenty-two states have already passed laws requiring smoke evacuation, including Georgia. There, it took several years and the testimony of nurse Angela Hohn, a runner who never smoked yet was diagnosed with stage four lung cancer. She died after Georgia passed its law.
“Our healthcare workers deserve better,” says Tuemler.
Tuemler says South Carolina can’t wait for the testimony of a dying nurse. It needs to act now.
She says doctors and nurses just want to help people heal. But they should not have to risk their own health to do so.
