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Silent But Deadly: The Ever-Present Dangers of Surgical Smoke

Surgical Smoke free ORs

We've all been there – that distinct, unpleasant smell that permeates the air in the operating room. Surgical smoke, a seemingly harmless byproduct of doing surgery, has a dark side that we desperately need to be talking about. While the smell is awful, it's not just the acrid odor that's the problem. So many operating room professionals are still unaware of the dangers lurking within these plumes, endangering our health every day.

What is surgical smoke?

Surgical smoke, also known as plume, is the hazardous airborne particles produced when energy generating devices like electrosurgical units, lasers, ultrasonic devices, and high-speed power equipment are used to cut or cauterize human tissue. These devices heat tissue cells to extremely high temperatures, vaporizing the tissue and releasing particles that contain cellular matter, viruses, and potentially infectious material. (1) What's alarming is that 77% of these particles are not adequately filtered out by our masks, making their way into our lungs with every breath we take. (2)

What are the risks?

Researchers began studying the effects of surgical smoke in 1976, and a study published in 1981 showed that surgical smoke is comparable to cigarette smoke, containing known and suspected carcinogens and mutagens. What's more, research has also shown that one day of exposure to surgical smoke in the OR can have the same impact as smoking up to 27 cigarettes. (1,2)

Research has shown that there are 150 different chemicals found in surgical smoke, 16 of which are listed as EPA priority pollutants. Moreover, there's a direct link between inhaling surgical smoke during excision of anogenital condylomata procedures procedures and the transmission of HPV to healthcare providers. (1)

The research on surgical smoke abounds, and the Occupational Safety and Health Administration (OSHA) even acknowledges that surgical smoke is dangerous. But despite this knowledge, OSHA does not specifically regulate exposure to surgical smoke. That regulation has been moved to the individual states.

What can we do?

How can we ensure a healthy working environment in ALL of our ORs? We must demand change within our workplaces and the healthcare industry as a whole. Here are a few steps we can take to make a difference:

  1. Educate Ourselves and Others: Stay informed about the risks of surgical smoke and share this knowledge with your colleagues. Awareness is the first step toward change.

  2. Advocate for Protective Measures: Work with your hospital administration and colleagues to implement proper smoke evacuation systems and protocols in every operating room. These systems can effectively filter out harmful particles, safeguarding both staff and patients.

  3. Support Research: Encourage and participate in research initiatives aimed at understanding the long-term effects of surgical smoke exposure. The more data we have, the stronger our case for protective regulations becomes.

  4. Lobby for Regulations: So far, 14 states have enacted surgical smoke evacuation legislation, with more states hopefully joining in 2024. If laws are not in place within your state, advocate with your state legislature to establish specific standards addressing protection from surgical smoke. And reach out to the trailblazing leaders who have already accomplished this feat! Learn from them, find out how they were able to get legislation passed, and work towards this goal in your state. You can also reach out to AORN for help getting legislation passed in your state.

Let's clear the air

As OR nurses, we are dedicated to the well-being of our patients. It's time that we used that same passion to not only advocate for our patients but to advocate for ourselves and our work environment. We need to advocate for change and educate about the dangers of surgical smoke. We have a right to breathe clean, safe air in the operating room and we really can create a cleaner, safer environment for everyone in surgical services. It's up to us to educate and advocate to make that change a reality.

Until next time,



  1. 2023 AORN Guideline for Surgical Smoke Safety, pgs 1107-1109

  2. Stryker Smoke Free OR

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