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The Movement to Address the Dangers of Surgical Smoke

The Movement to Address the Dangers of Surgical Smoke

Healthcare workers face a number of risks in their daily lives, like catching an infection or dealing with violent patients. One less well-known issue is the danger of surgical smoke.


What Is Surgical Smoke?

Surgical smoke is produced when lasers and electrosurgical devices are used on tissue. It smells repulsive, is disgusting in concept, and carries risks for both staff and the patients. It can:

  • Obscure the surgeon’s view, resulting in more mistakes. Clearing the smoke can result in delays.
  • Contain viruses and bacteria. Specifically, HPV transmission (human papillomavirus), and they found other viruses in smoke including HIV, polio, and hepatitis B.
  • Cause eye, nose and throat irritation, headaches, coughs, and nasal congestion
  • Aggravate asthma.
  • Cause chronic bronchitis.
  • There’s some indication it may have similar effects to tobacco smoke.
  • The smoke can cling to the person’s hair, resulting in a lingering bad odor.
  • Workers have also complained of nausea, drowsiness, and dizziness.

Healthcare workers risk the most. This includes about 500,000 health care workers, many of them OR nurses. The smoke contains infectious agents, viable malignant cells, a variety of carcinogens including 1,3-butadiene, vinyl acetylene and acrylonitrile, and toxins including hydrogen cyanide, benzene, formaldehyde and an entire laundry list of potentially dangerous chemicals. We don’t know all of the long-term effects, but we do know perioperative nurses are twice as likely to have respiratory issues as the general population. Additionally, the smoke sometimes escapes the OR and effects other workers and patients.


What to Do?

The Movement to Address the Dangers of Surgical Smoke


The best way to reduce the dangers of surgical smoke is to use a local exhaust ventilation (LEV) system, Room-wide ventilation systems are also useful for small amounts of smoke. Smoke-evacuating tools such as the ONETRAC LX can be useful if the source of smoke is a single site. Technology is producing solutions that range from integrated suction in booms and ESU pencils with tubing and filters.

However, in a CDC survey, less than half (47%) of respondents said that LEV was always used during laser surgery. However, only 14% said it was always used during electrosurgery. One in three said LEV systems were not used at all.

The other helpful thing is to use an N95 mask rather than a standard surgical mask for procedures which might generate smoke or when dealing with patients that are positive for certain viruses including HPV (of particular concern because laser and electrosurgical procedures are often performed to treat cervical cancer). However, some people find an NP5 mask to be too heavy, and a balance has to be found – the masks can cause shortness of breath, thermal discomfort, headaches, and visual challenges. Workers should also consider eye protection.

Most importantly, use smoke evacuation for every procedure that generates smoke. Tain workers to use both evacuation and proper PPE becomes second nature. One huge obstacle is that a lot of surgeons don’t like changing the way they have always done things. in-built evacuation systems can make tools heavier, and many evacuation systems add distracting noise. This may well be why nurses are driving the movement to address the dangers and make the operating room safer for patients and staff alike.


The State of the Movement

Surgical smoke has only recently become a major cause of concern, although the problem has existed for a long time. Awareness has been low, and awareness outside of healthcare is minimal.

OSHA does not, currently, specifically require the evacuation of surgical smoke. The National Institute for Occupational Safety and Health (NIOSH) uses both LEV and general room ventilation. And while OSHA has no specific standards, they do consider surgical smoke to be hazardous and may issue citations as a response to complaints under rules covering respiratory protection and air contaminants.

Although there has been no movement at the federal level, a growing number of states are starting to pass laws mandating surgical smoke evacuation. Utah, for example, is currently holding hearings on SB105, which requires surgeries to develop policies to eliminate exposure.

A similar bill passed in Kentucky and introduced in Oregon, Georgia, and New Jersey. Two other states already have legislation in place: Colorado and Rhode Island. California has discussed legislation, but not put any in place.

In Utah, the efforts of nurses, some of whom showed up to hearings in their scrubs, drew attention to the problem. The Utah Nurses’ Association formed to lobby for surgical smoke prevention after a study found that surgical smoke contains some of the same carcinogens as cigarettes.

At other levels, the AORN has created the Go Clear program, which includes in implementation manual and other materials to help facilities develop smoke evacuation procedures. The program comes with awards rating facilities on education, smoke evacuation, and equipment. It proves to increase compliance.

Health care providers are also starting to voluntarily address the problem. For example, a large provider in Minneapolis adopted a zero-tolerance policy requiring evacuation systems.



Most importantly, increasing awareness, especially amongst those most affected, occurs. The best system in the world achieves nothing if not used. Healthcare workers need to realize the danger and use the tools they can to solve problems.

While putting in room-wide systems may take time, there are local tools surgeons can use to reduce their smoke exposure and that of their assistants, nurses, and patients. These tools can help evacuate smoke into a hazardous waste bag, protecting everyone from the risk of respiratory disease. To find out more about the OneTrac-LX and other tools that can help, contact obp today.


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