06 Aug The Nurse, the Surgeon and now, the Healthcare Executive

For the past few months we have focused our comments on data to support education of clinicians who have been reluctant to accept, let alone advocate for, smoke evacuation technology in their operating rooms. As a result of our literature reviews and original research, sponsored by Nascent Surgical, LLC at world class independent testing laboratories, we have had the opportunity to contribute to the discussion as to why hospital facilities should evacuate surgical plume.

Such data have revealed that:

1. Chronic inhalation of nanoparticles (80% of organic plume) is associated with multiple systemic diseases. Further, the ultimate effects of inhalation are dependent upon genetics, pre-existing illnesses and dose/duration of exposure.¹
2. Such exposure can lead to premature death.²
3. The Company has developed a disposable, easy to apply device with a documented 98-100% smoke capture efficiency.³
4. Use of the device called, “miniSquair”” or simply, “the mini,” when connected to a smoke evacuator capable of generating 25cfm of air flow or greater, can, under controlled laboratory conditions:

1. Prevent aerosols of bacteria derived from blended current electrosurgery of contaminated meat
2. Decrease simulated wound contamination by over 50%.⁴

Such data strongly argues for clinical trials to confirm if such effective smoke capture can decrease the rate of surgical site infections.

Why have I accented this data to clinicians rather than to push marketing efforts at segmentation and brand recognition? As a former practicing surgeon, I believe in contributing to the profession, in the past through lasers,⁵ laparoscopy,^6,7 and the development of a laparoscopic filter⁸ and now protecting operating room workers and the patients that they serve.

Despite these efforts, I have largely neglected an important party to the discussion…education of the healthcare executive who is charged with evaluating how new technology conforms to the latest mantra of “value-based healthcare.” If you cannot show improved outcomes at a lower cost, then you will not get through the front door. So let us try….

Clean air in a populated, closed environment has been proven to reduce absenteeism⁹ and to increase productivity.¹⁰ Such benefits do not easily equate to a monetary advantage since administrative duties in the O.R are secondary to patient-related clinical functions. In other words, to prevent delays in the surgical schedule, resource nurses/managers will replace those that call in sick thus eliminating overtime costs. How to relate a healthier working environment to increased productivity with potential cost savings or revenue enhancement is a job for wizards. There is no question however, that a plume-filled room over time has increased the incidence of respiratory illnesses in perioperative nurses but the cost of this must be individually assessed.

With the above stated, the long-term cost to ever-expanding health systems, many of whom choose to self-insure, is another matter. Clinicians will soon become aware of the relationship between chronic inhalation of nanoparticles and the development of diseases as previously revealed. The executive must soon consider the potential cost to the system of health-related workman compensation claims and potential civil suits through the legal theory of “vicarious liability.”¹¹ Remember that the federal government guidelines require the employer to provide a safe working environment¹² which means protection against harmful smoke. At one time, this stated mandate was near impossible to accomplish but not now. Current technology makes such protection possible and at minimal cost. The executive should contemplate a television advertisement that says, “If you have been working in an O.R. for 10 years or more and have been diagnosed with any of this list of diseases associated with long-term smoke inhation, call us at 1-800 Bad Smoke.” The asbestos-mesothelioma linkage cost industry $30 billion dollars; the nanoparticle exposure and resultant disease relationship so often discussed in the environmental journals^13,14 but not in clinical journals, will very likely end up costing health systems even more.

It would be best for healthcare executives to be proactive and to do the right thing for the right reason. Hospitals should enact smoke evacuation policies NOW and should promote best practice purchases to make clean air in the O.R. a reality.

Next time, we’ll discuss how to achieve significant savings while practicing effective smoke evacuation in the entire operating room suite.

Reference List

1. Buzea C, Pacheco II, Robbie K. Nanomaterials and nanoparticles: sources and toxicity. Biointerphases. 2007; 2(4): MR 17-MR 71.
2. Loden F, Neas LM, Dockery DW, Schwartz J. Association of Fine Particulate Matter From Different Sources With Daily Mortality in Six U.S. Cities. Environm. Hlth. Perspect. 2000; 108(10): 941-947.
3. Schultz LS, Drogue J. Unique devices for efficiently removing surgical plume. Surg. Serv. Manage. 2000; 6(4): 8-12.
4. Schultz L. Can Efficient Smoke Evacuation Limit Aerosolization of Bacteria? AORN J. July, 2015; 102(1): 7-14
5. Schultz LS, Hickok DF, Graber JN, Stephens WE. The use of lasers in general surgery. Minn. Med. 1987; 70(8): 439-442.
6. Schultz LS, Kamel MK, Graber JN, Hickok DF. Four Year Outcome Data for 400 Laparoscopic Cholecystectomy Patients: Recognition of Persistent Symptoms. J. Int’l Surg. 1994; 79: 205-208.
7. Schultz LS, Cartmill J, Graber JN, Hickok DF. Laparoscopic Herniorraphy, Transabdominal Preperitoneal Procedure. Seminars in Laparoscopic Surgery. 1994; 1: 98-105.
8. Rudolph R. Solutions for Surgical Plume. Surg. Prod. Mag. August, 2015: 16-20.
9. Gilliland FD, Behane K, Rappaport FB, et. al. The Effects of Ambient Air Pollution on School Absenteeism Due to Respiratory Illnesses. Epidemiology. 2001; 112(1): 43-54.
10. Indoor Air Quality and Student Performance in EPA Series 402-K-03-006, Revised August, 2003.
11. Landess W. Surgical Administrators Targeted in Lawsuits. Outpatient Surg. Mag. 2012; March: 16-17.
12. OSH Act of 1970 Standard 1910.134. Respiratory Protection, para. (a)(1) and 1910.1030(b), Regulated Waste and Universal Precautions. Available at: http://www.osha/gov/pls/oshaweb/owadisp.shodocument?ptable+s? Accessed on 31 January 2014.
13. Delfino RJ, Sioutas C, Malik S. Potential role of ultrafine particles in association between airborne particle mass and cardiovascular health. Environm. Hlth. Perspect. 2005; 113(8): 1250-1256.
14. Brown RC, Lockwood AH, Sonowana BR. Neurodegenerative diseases; an overview of environmental risk factors. Envirnm. Hlth. Perspect. 2005; 113(4): 934-946.