An Exhaustive 3-Year Quest for 12 Smoke-Free ORs

Northwest Hospital is the first hospital in Maryland to be completely smoke-free.

Northwest Hospital, a LifeBridge Health Center in Randallstown, Md., is the first Maryland hospital to be completely smoke-free. Leading the charge was Debra Kording, BSN, RN, CNOR, the perioperative educator who was moved and motivated by the horrid things she learned about surgical smoke from AORN’s Surgical Smoke Tool Kit. For example:

• Using electrosurgery on 1 gram of tissue is like inhaling the smoke from 6 cigarettes in 15 minutes.
• Using the CO2 laser on 1 gram of tissue is like inhaling smoke from 3 cigarettes in 15 minutes.

Ms. Kording’s concerns intensified when she thought about all of the smoke she had inhaled over the course of her 30 years as an OR nurse, and all ofit the staff at Northwest inhaled, within as well as outside the OR (surgical smoke would drift down to PACU). That smoke, she learned, is filled with particulates, such as carbonized tissue, blood and viruses, and toxic substances such as benzene,toluene and other carcinogenics.

She soon noticed her colleagues complained about coughing and respiratory problems. She didn’t chalk it up to coincidence. It also was hard to escape the heavy stench of smoke and charred flesh shrouding a hospital that last year alone used electrosurgery on 5,066 patients.

“The electrosurgery pencil is the workhorse of most every surgical procedure,” says Ms. Kording.“When you’d walk into an OR, the smell would knock you over.”

It scared Ms. Kording to think of all of the surgical smoke hospitals produce nationwide because there’s no federal legislation demanding its evacuation from the OR. Only one state, Rhode Island, has passed a state law mandating smoke evacuation.

Hospitals have been using an electric current to cut and coagulate tissue during surgery for more than 40 years. It’s a lot faster than scalpel and suture, but burning all of that tissue produces a lot of smoke.

‘We had to convince our surgeons’

Ms. Kording gathered facts and figures and put them in a PowerPoint to share with her surgeons, who most likely were unaware of the collateral damage they were causing.

“We didn’t have to convince staff and leadership,”says Ms. Kording. “We had to convince our surgeons.”

Not everyone was ready to give their full attention to the issue of burning tissue. And that’s not surprising. Although the dangers of surgical smoke have hovered like a black cloud over ORs everywhere for more than 30 years, not much has been done about it. Smoke evacuation equipment can cost quite a bit, and older models can be noisy and bulky.

Instead of taking on the surgeons on her own, she decided to seek out a physician champion she knew could hold sway with his colleagues. She looked to Chief of Surgery Mark Katlic, MD. “He is all about supporting issues that relate to all of us,” says Ms. Kording. Dr. Katlic was an eager evangelist. She showed him her PowerPoint and he said:

“Take this to all of the surgical division chiefs. Tell them to show it to all of their surgeons.” He also asked Ms. Kording to present on the hazards of surgical smoke during the department of surgery’s quarterly meeting.

Dr. Katlin got the much-needed buy-in from his fellow surgeons. Together, they got 3 more physician champions to join the cause: Christina Li, MD, Celine Richardson, MD, and Janet Woodyard, MD.

“I was blessed when 4 surgeons got behind me,” says Ms. Kording. “I reminded them that anything that is in their patients comes out into the air during surgery. They said, ‘Oh, my gosh; I knew surgical smoke wasn’t a good thing, but I didn’t know how bad it was!’”

Breathing easier in the new year

Finally, on Jan. 3, years after starting her crusade, Ms. Kording got the backing she needed for smoke-free ORs. She, the physician champions, surgical services leadership and the hospital’s Surgical Services Best Practice Council came together to implement a smoke evacuation program. They arranged to trial 2 smoke evacuator systems.

A clear winner emerged, but it would cost $119,000 to outfit each of its 12 ORs. Monique Holzer, MS, RN, the director of surgical services, reworked the budget, making smoke evacuators a priority over the purchase of some other items. The hospital went live with smoke evacuation systems on May 2. It also purchased specialized filters to minimize patients’ absorption of carbon monoxide and toxic chemicals from surgical smoke produced during laparoscopic procedures.

“Staff are much happier now that they work in a smoke-free environment,” says Ms. Kording. “Our pre-op and PACU areas are free of smoke as well. The noxious smell no longer wafts down the hall-way and throughout the department. The staff and patients at Northwest Hospital are now breathing easier.”