Surgical Smoke Evacuation Update

May 28, 2024
AORN comments on legislation surrounding surgical smoke.

In 2022, Healthcare Purchasing News (HPN) reported that legislation in New York (S.8869 (Rivera) / A.9974 (Gottfried)) advancing AORN’s efforts to mitigate surgical smoke in the workplace was signed by Governor Kathy Hochul on December 16, 2022, as Chapter 701 of the Laws of 2022. New York is the tenth state in the U.S. to enact legislation that requires all licensed hospitals and freestanding ambulatory surgical facilities to adopt policies to use a smoke evacuation system for surgical procedures that generate surgical smoke. The law will take effect on June 14, 2023.

According to the Occupational Health and Safety Administration (OSHA), each year “an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke.” This smoke, also known as plume, includes carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases. Prolonged exposure can lead to serious and life-threatening respiratory diseases.

As advocates for surgical nurses’ workplace safety, the Association of periOperative Registered Nurses (AORN), supported by the New York Nursing Alliance and the American Nurses Association of New York among others, spearheaded the law’s passage to protect operating room staff and patients from the dangers of surgical smoke, a by-product from the use of energy-generating devices.

Late last year, HPN reported that the California Nurses Association (CAN) applauded Gov. Gavin Newsom’s signing of A.B. 1007, a bill that requires the development and adoption of enforceable workplace health and safety protections from surgical smoke in California hospitals. The bill was authored by Assemblymember Liz Ortega and sponsored by CAN.

This month, HPN caught up with Jennifer Pennock, associate director, Government Affairs, AORN about smoke evacuation, including a current legislative initiative the association is involved with.

What is surgical smoke and why is it dangerous?

Surgical smoke contains over 150 hazardous chemicals and carcinogenic and mutagenic cells. It contains toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, blood fragments, and viruses.

According to the Environmental Protection Agency, exposure to fine particulate matter in surgical smoke is associated with cardiovascular and respiratory health problems. In addition to causing respiratory illness, asthma, and allergy-like symptoms, surgical smoke may contain viruses, such as HPV. There are documented cases of HPV transmission from patients to providers via surgical smoke inhalation. Surgical smoke can cause cancer cells to metastasize in the incision sites of patients having cancer removal surgery.

Can you share some of AORN’s initiatives for tackling this problem?

Smoke evacuation legislation has been enacted in 17 states thus far, and many more states have taken the issue under consideration. Thanks to AORN members and advocates across the country, legislators have recognized the need to protect OR staff and patients from the harms of surgical smoke.

Through AORN’s Center for Excellence Go Clear Program, AORN members have taken their facilities surgical smoke-free. This program enacts a comprehensive approach to ensure a smoke-free environment wherever surgical smoke is generated to protect patient and worker safety. As that program has grown, so too has legislative advocacy for statewide policy change.

Are there any technologies that can remove surgical smoke? What are these technologies?

AORN recommends use of a smoke evacuation system (e.g., portable smoke evacuator with filtration, medical-surgical vacuum with an in-line filter, centralized stationary smoke evacuation system) to evacuate and filter all surgical smoke.

Have there been advancements in this space in the last few years?

Over the years, equipment has become less bulky and quieter, addressing two complaints surgeons often had when explaining their decisions not to use the equipment. As the equipment has improved and companies have educated surgeons about the products available, more surgeons have become adopters of the technology. Additionally, more products have come on the market with growth in use of smoke evacuation systems.

Is removing surgical smoke voluntary for hospitals right now?

It is voluntary in states where surgical smoke evacuation laws are not in effect.

Why has this issue been overlooked until recently?

Until recently, many surgical team leaders and facilities assumed surgical smoke was harmless, similar to the early beliefs about cigarette smoking. In addition, smoke evacuation equipment used to be loud and bulky. Today, with new technology that is rapidly evolving, the devices are smaller and more effective, though too many surgeons and facilities have yet to trial these improved devices. AORN has been educating our members for years on the hazards of surgical smoke, and our members have turned that education into advocacy for policy change.

What does AORN want our readers to know regarding legislation/initiatives?

Change doesn’t happen overnight, but a law requiring the evacuation of surgical smoke will change surgical safety in your state. And with AORN’s Go Clear program, you can take your facility surgical smoke-free in advance of a law in your state.

Where do you see this space in the next 5-10 years?

We will continue to see more facilities Go Clear and anticipate continued progress on the policy front.

About the Author

Janette Wider | Editor-in-Chief

Janette Wider is Editor-in-Chief for Healthcare Purchasing News.