Dosher OR Clears the Air: Smoke-Free Environment for Patients, Staff

Ophthalmologist and ocular plastic surgeon Dr. Alan (Chip) Oester demonstrates the use of the Stryker Neptune E-SEP pencil that has removed caustic smoke from OR procedures.
Ophthalmologist and ocular plastic surgeon Dr. Alan (Chip) Oester demonstrates the use of the Stryker Neptune E-SEP pencil that has removed caustic smoke from OR procedures.

This article originally appeared in

By Terry Pope, Associate Editor

It may be just a small, critical access hospital, but Dosher Memorial in Southport has put itself on the cutting edge of operating room technology by creating a smoke-free environment for its staff.

When surgeons use cautery tools on patients, the released smoke in the operating room can be filled with caustic, carcinogenic particles that they and staff breathe in. According to Dosher operating room director Kim York, it’s like smoking 27 cigarettes per day.

York spearheaded a move to eliminate the smoke, and Dosher administrators, trustees and employees all agreed to give it a try, at a reasonable cost. Today, they vow there is no going back to their old ways inside the OR.

“It has been known that smoke in the operating room is a bad thing,” said York. “You are exposed to chemicals that are known to cause cancer. And it smells so bad. We decided we just didn’t want to breathe this anymore.”

Surgeons tried several different models of smoke evacuation pencils before they agreed on a Stryker product: the Neptune E-SEP. It has a small tube that suctions the smoke from incisions into a filter machine inside the OR.

Ophthalmologist and ocular plastic surgeon Dr. Alan (“Chip”) Oester says he performs 800 to 1,000 operations per year and welcomed the change at Dosher—for himself and his patients.

“I can’t be breathing that in for 30 years,” stated Dr. Oester.

For some of his procedures, patients are placed under local anesthesia and are still aware of what they may smell in the OR. Some doctors tell patients that the smell is just a little bit of cotton burning, Dr. Oester said.

“They know exactly what is burning,” said Dr. Oester. “It’s really disconcerting to the patient.”

Surgeons like Dr. Oester all had to buy-in to the changes at Dosher for it to work, said York. That’s why the Stryker model and its fit in surgeons’ hands was key to making the switch.

“I wasn’t hesitant at all because it was pretty simple,” said Dr. Oester. “It feels no different. It gives you better visualization.”

Some hospitals attempted to evacuate the smoke by using a separate suction hose that tied up an assistant’s hands and kept getting in the way of the procedure. Until a better model was built, hospitals have been hesitant to change.

Dosher CEO and president Tom Siemers said creating smoke-free operating rooms for staff and physicians is a subject that has never been discussed at the numerous hospital conferences he has attended. After observing a live knee replacement in Dosher’s OR, Siemers realized it is an issue that should be addressed.

“They didn’t tell me it was going to smell like that,” said Siemers. “We’ve got to make sure it’s a safe environment for our team to work.”

There is a price to pay, especially for small rural hospitals like Dosher that must constantly watch the bottom line. The cost for the disposable cautery pencils will go from about $5 to $20 each.

“That is pennies compared to when we buy equipment,” said Siemers. “But we are providing a safer environment for our patients and our staff. We want to do the right thing for the right reason.”

Certified registered nurse anesthetist Barry Amerson is among the Dosher employees exposed to operating room smoke on a daily basis. He said he witnessed other attempts with “garden hose-type devices” at other hospitals that were not well received.

“They captured with this one a design that is much like what the surgeons are used to using,” said Amerson. “There’s a lot of smoke. I think it’s never been a focus for hospitals.”

Siemers said the change at Dosher was driven by the surgical team up, and that getting all surgeons to agree to transition was the key. York said she actually expected more resistance.

“We just knew that the surgeons were going to be a problem,” said York. “We knew they would react: ‘Why do I need to change? I like what I’m doing. I probably already have everything I’m ever going to catch.’”

She slowly sought change by placing in the break room material about the danger of OR smoke. She brought in samples for the staff to actually hold. It seemed to work.

“We decided that we’re doing it, and we’re doing it for one reason really: to protect our hospital workers and patients,” said York.

During that transition, Dr. Oester said he read a book, When Breath Becomes Air, written by neurosurgeon Paul Kalanithi, who at age 36 was diagnosed with stage IV lung cancer. Kalanithi died while in the process of completing the book.

The book and Dosher’s effort to go smoke-free was a revelation for Dr. Oester.

“I told myself, if I get lung cancer I’m going to be so upset,” he said.

Being a nurse is York’s second career. When she found herself inside the OR exposed to smoke on a daily basis, she saw a need for change. Sometimes there are five to 10 hospital workers inside the OR with the ventilation system distributing the smoke all across the room, exposing everyone inside.

“I’m kind of a rock-turner,” said York. “I look for things that need to be better.”

Siemers credits York’s leadership for making the change.

“You have to have someone like Kim to make it happen,” said Siemers. “She quarterbacked this all the way through to make it happen.”

York said she is pleased hospital administrators and trustees gave their blessing to move forward with the project.

Recent legislation introduced in California will try to make all hospital operating rooms in that state smoke-free. It is something Siemers said he’d like to see in North Carolina.

“I absolutely feel that OSHA (Occupational Safety and Health Administration) or the state should make sure they have standards in place for hospitals to operate,” said Siemers. “They do it for everything else. I think it should be a state law.”

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