Anthony K. Hedley, MD, FRCS

In 2013, orthopedic surgeon Anthony K. Hedley, MD, FRCS, was diagnosed with idiopathic pulmonary fibrosis (IPF), a disease that's as bad as it sounds. Irreversible and ultimately fatal, IPF causes scar tissue to grow inside your lungs. At age 70, he underwent a life-saving double lung transplant.

What else could have caused this, he thought, but 40 years of smoking? No, he'd never touched a cigarette, but he had inhaled the surgical plume from nearly 11,000 joint replacements.

"That's 30 to 40,000 hours. That's a lot of exposure," he says. "I've made a lot of Bovie smoke in my day."

Bovie smoke. That's what he calls the byproduct of high-heat electrical tools used to cut and cauterize skin and tissue during surgery.

"It's noxious. There's nothing nice about it," says Dr. Hedley. "It smells like a barbecue. Either you're burning flesh or you're burning fat. Some nasty things come out of Bovie smoke."

Nasty is a good word. Consider:

• Surgical smoke contains about 150 chemicals, including 16 EPA priority pollutants, toxic and carcinogenic substances, and viruses and bacteria. As early as 1988, researchers published studies that revealed the presence of mutagens, carcinogens, and viable disease-causing cells in the smoke plume produced by heat destruction of human tissue.
• The smoke produced in an OR every day can be equivalent to smoking as many as 30 unfiltered cigarettes. That's 1 ? packs of Pall Malls a day.

And yet exposure to surgical smoke remains one of the largest unaddressed health hazards facing operating room staff today. Will it remain that way?

Not if Dr. Hedley can help it.

Lucky to be alive, let alone back to reconstructing hips and knees at the Phoenix, Ariz.-based Hedley Orthopaedic Institute, Dr. Hedley is on a crusade to encourage surgeons who use electrocautery to use a smoke evacuating pencil. "It could save your life," he says.

Help could be coming in the form of smoke evacuation legislation out of California, which would become the first U.S. state to make surgical smoke evacuation mandatory. Assembly Bill 402 would require California healthcare facilities to use "plume-scavenging systems" in any setting in which a surgeon's use of an electrocautery device or any other electrosurgical device creates surgical smoke. The bill would also require manufacturers of smoke-evacuation systems to provide evidence that their systems meet specified minimum requirements when installed, operated and maintained as instructed.

California lawmakers attempted to pass similar legislation last year, but Gov. Jerry Brown vetoed it. It is hoped that if California passes a law that makes smoke evacuation mandatory, other states will follow suit.

Until that time, Dr. Hedley urges you take it upon yourself to protect your surgeons, staff and patients by adopting technology that eliminates surgical smoke. Smoke evacuation pencils with built-in or clip-on suction tips that remove smoke and particles at the source are a simple and inexpensive way to bring smoke evacuation capabilities to your ORs, he says.

"The advent of these evacuation tips is a very solid thing. I think we need to spread the word," says Dr. Hedley. "The only downside is they're a little more cumbersome to handle than a standard Bovie. The suction tip comes with a tube attached the makes it a little unwieldy. Just persevere and get used to it. Accept a little bit of inconvenience for the sake of everyone else in the OR." OSM