Expert Advice

Kay Ball, PhD, RN, CNOR, FAAN

Past President AORN 

Perioperative nurses and the other members of the surgical team are becoming painfully aware of the many hazards of inhaling surgical smoke. The offensive and pungent odor (caused from toxic gases that may be carcinogenic), the small size of the particulate matter (that can settle in your own lungs or clog up a wall suction device), and the potential for the transmission of pathogens that can cause disease, are finally at the forefront of conversations in the OR.

Today we have the technology to evacuate ALL surgical smoke so why are smoke evacuators and filtration devices not being used consistently? AORN has taken a leadership position by publishing their position statement that was ratified overwhelmingly by the AORN House of Delegates on April 3, 2008. This statement (see below) officially announces AORN’s stance that all surgical smoke must be eliminated to provide a safe workplace environment – not just in the OR but in every setting where surgical smoke is generated (ERs, clinics, endoscopy suites, physician offices, etc.) This position statement along with AORN’s and ORNAC’s recommended practices provide detailed information for the formation of individual hospital policies and procedures.

Research has conclusively demonstrated that surgical smoke is hazardous, equipment and supplies are available for effective evacuation, and evidence-based recommendations are published to provide guidance for smoke evacuation practices – now we need is action!  “Become Nasti” and ensure you’re not exposed to these harmful inhalation contaminants.


AORN recognizes that exposure to surgical smoke and bio-aerosols poses a hazard to patients and perioperative professionals. Smoke and bio-aerosols are routinely produced by surgical instruments; eg, lasers, electrosurgical units, radiofrequency devices, ultrasonic devices, power tools. Research studies have confirmed that plume and bio-aerosols contain odor-causing and odorless toxic gases, vapors, dead and live cellular debris (including blood fragments), and viruses.1-7 These airborne contaminants can pose respiratory, ocular, dermatological and other health-related risks, including mutagenic and carcinogenic potential, to patients and operating room personnel.1-7

OSHA estimates that 500,000 health care workers are exposed to surgical smoke each year.8 Although the long-term deleterious effects from exposure to surgical smoke and bio-aerosols have not been clearly established, AORN supports the need to be proactive to prevent harm. Understanding the environmental hazards of surgical smoke and bio-aerosols produced during operative and invasive procedures is paramount to the implementation of adequate protective measures for both patients and personnel involved in their care. AORN also recognizes that this hazard exists in practice areas that extend beyond the perioperative environment, such as obstetrical surgical services, cardiac cath labs, emergency rooms, interventional radiology, endoscopy suites, clinics, and physician offices.

AORN believes that exposure to surgical smoke and bio-aerosols can and should be controlled. Health care professionals are responsible for learning about surgical smoke and bio-aerosols and taking steps to minimize the risks associated with these hazards.

AORN recommends the following risk reduction strategies:
  • Use local exhaust ventilation (.1 micron filtration at 99.999% efficiency)
    • Central smoke evacuation systems
    • Portable smoke evacuation units
    • Wall suction with inline filter
    • Laparoscopic evacuation/filtration systems
  • Use personal protective equipment
    • High filtration surgical masks worn properly
    • Protective eye wear
    • Skin protection (eg, gloves)
  • Educate perioperative staff
    • Develop and implement training programs
    • Demonstrate competencies on equipment and supplies
    • Comply with federal, state, and local regulations and standards
    • Document and maintain educational activities
  1. Barrett WL, Garber SM. Surgical smoke—a review of the literature. Business Briefing: Global Surgery. 2004;1-7.
  2. Pillinger SH, Delbridge L,Lewis DR. Randomized clinical trial of suction vs standard clearance of diathermy plume. Br J Surg. 2003;90(9):1068-1071.
  3. Taravella MJ, Viego J, Luiszer F, et al. Respirable particles in the excimer laser plume. J Cataract Refract Surg. 2001;27(4):604-607.
  4. Karoo ROS, Whitaker IS, Sharpe DT. Surgical smoke without fire: the risks to the plastic surgeon. Plast Reconstr Surg. 2004;114(6):1658-1660.
  5. Garden JM, O’Banion K, Bakus AD, Olson C. Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol. 2002;38:1303-1307.
  6. Hollmann R, Hort CE, Kammer E, Naegele M, Sigrist MW, Meuli-Simmen C. Smoke in the operating theater: an unregarded source of danger. Plast Reconstr Surg. 2004;114(2):458-463.
  7.   Alp E, Biji D, Bleichrodt RP, Hansson A, Voss A. Surgical smoke and infection control. J Hosp Infect. 2006;62:1-5.
  8. OSHA (n.d.). Lasers and Electrosurgery Plume. . Accessed August 25, 2007.



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You're At RISK

Surgical plume can carry dangerous bacteria and viruses, including HIV. As such, they can produce upper respiratory irritation, and have in-vitro mutagenic potential.

More than 500,000 healthcare workers are exposed to laser or electrosurgical smoke each year in North America, including surgeons, nurses, anesthesiologists, and surgical technologists. When the Smoke Evacuation System is turned on, everyone can Breathe Easy. Want to Clear the Air of Surgical Plume?

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