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Thanks to the persistence of nurses around the country, renewed efforts are under way toward a federal "technical information bulletin" on the hazards of surgical smoke. Three nursing organizations formed a joint task force on surgical smoke and urged their members to contact the National Institute on Occupational Safety and Health (NIOSH) with anecdotal reports of surgical smoke effects.
A NIOSH researcher set up an internal working group and agreed to make site visits to hospitals to look into surgical smoke concerns, says Candace Romig, MS, director of governmental affairs at the Association of periOperative Registered Nurses (AORN) in Denver.
"NIOSH may help persuade OSHA [the Occu-pational Safety and Health Administration] that enough data have already been gathered to warrant the release of the [surgical smoke] guideline," says Romig. AORN is working with the American Association of Occupational Health Nurses (AAOHN) in Atlanta and the American Association of Nurse Anesthetists in Park Ridge, IL.
Early last year, nursing advocates were expecting the imminent release of a technical information bulletin on surgical smoke. Romig and others had even reviewed a draft copy. But then OSHA officials abruptly decided to put a hold on the bulletin, saying they needed more scientific evidence.
"Essentially, the word from them was we can’t move forward with anything unless we have some research that’s going to show a definitive causality," says Kae Livsey, RN, MPH, public policy and advocacy manager of AAOHN. "What they have is a lot of anecdotal information."
When human tissue burns, either in electrosurgery or laser procedures, cells burst and tiny particles become airborne in a noxious plume. OR nurses report suffering from nausea, abdominal cramps, and respiratory problems after hours of breathing surgical smoke. (For more information on surgical smoke and evacuation devices, see Hospital Employee Health, April and July 2000.)
There is, in fact, research that indicates that surgical smoke carries harmful and even infectious material. Studies have identified particulate matter in surgical smoke that is small enough to pass through surgical masks and toxic chemicals, such as benzene, toluene, and acrolein.
In one case, a surgeon contracted laryngeal papillomatosis with human papillomavirus DNA types that were identical to those of patients he had treated with laser therapy. The virus may have been transmitted through the laser plume, the treating otorhinolaryngologists concluded.1
NIOSH, the research arm of OSHA, issued a hazard alert in 1998, and the American National Standards Institute issued standards in 1996 calling for the evacuation of laser and electrosurgical smoke.
Still, in many hospitals, smoke is routinely evacuated from lasers but not from electrosurgery units, which are used in 75% to 80% of all surgical procedures. Nursing leaders say a document from OSHA would influence many hospitals to provide better smoke evacuation from electrosurgical as well as laser procedures. (Normal room ventilation is considered inadequate; several different types of devices are available to remove the smoke directly from the surgical site.)
Although the bulletin would be informational only, the legal and political challenges faced by OSHA apparently influenced its delay. OSHA is seeking evidence that links prolonged exposure to surgical smoke to a rise in illness or injury among operating room staff.
Through NIOSH, the three nursing organizations are working to help establish that link. "We’re feeling hopeful that we now have another body that’s listening to us," says Paula Graling, RN, MSN, CNOR, clinical nurse specialist for perioperative services at Inova Fairfax Hospital in Falls Church, VA, and chairwoman of the task force.
In addition to conducting surveys within OR specialty groups, AORN plans to review data from the Harvard Nurses Study, a longitudinal study that contains detailed information on the health of nurses.
Meanwhile, employee health professionals can help by encouraging employees and supervisors to report symptoms that may be associated with surgical smoke, says Livsey. "We’re raising awareness on behalf of our members to be looking for these symptoms."
1. Hallmo P, Naess O. Laryngeal papillomatosis with human papillomavirus DNA contracted by a laser surgeon. Eur Arch Otorhinolaryngol 1991; 248:425-427.