The issue and hazards of surgical
smoke have long been discussed.
So why isn’t everyone already on
As with many new concepts,
these things take time. According to
a review by The Journal of Hospital
Infection, over 500,000 people
are exposed to surgical plumes
each year. These plumes can be
the byproduct of electrosurgical or
laser procedures and carry many
potential hazards to surgeons,
operating room staff, and patients.
Have you ever wondered
why your hospital mandates the
removal of laser plume but not the
smoke created by electrosurgery?
Is electrosurgical smoke less
Research by Dr. Yoshihiro Tomita
and his colleagues note that when
electrosurgery is used to vaporize
one gram of tissue, inhaling the
resulting plume would be like
smoking six unfiltered cigarettes,
while using a laser would be like
smoking three unfiltered cigarettes.
So, why then are we still
breathing in all of the toxins found
in electrosurgical smoke when laser
plume continues to be diligently
Advocate groups like the
Association of periOperative
Registered Nurses (AORN) and
the International Council on
Surgical Plume (ISCP) are making
headway, but without the incentive
of government mandates, facilities
make the decision for themselves.
How To Create A
Environment From The
So how does a surgical center
or hospital achieve a smoke-free
The most obvious place to begin
is the point of service (those taking
direct care of the patients, i.e.,
nurses, surgical techs, etc.), so the
focus for initiation must begin with
Staff members are especially
critical to the system’s ability to
adapt and thrive. Enlisting their
help in convincing colleagues that
smoke evacuation is vital to their
own health, along with patient
safety, can be much more effective
than a top down mandate.
Some strategies to create a
smoke-free environment from the
bottom up include the following:
1. Determine who the smoke-free
champion will be and then give
him or her responsibility and
authority to initiate the smoke-free program.
2. Change physician procedure
cards to reflect smoke
evacuation supplies that
are needed during specific
3. Put smoke evacuation supplies
in custom packs.
4. Gain total support from staff
members through education
while stressing the negative
By Kay Ball, PhD, RN, CNOR, CMLSO, FAAN, Professor of Nursing, Otterbein University
It’s time for facilities to make every OR smoke free.
Kay Ball, PhD, RN
Professor of Nursing
This is why the presence of
devices which remove surgical
smoke from the air has become
increasingly important as
electrosurgical procedures have
become more common.
When it comes to limiting
surgical smoke exposure, the risks
are very real and the lack of action
we're taking is quite disconcerting.
However, there are some specific
things you can do to make your OR
100 percent smoke free.