What Is Surgical Smoke And Why Is It More Dangerous Than Most OR Staff Realize
- Ginny Yelverton BSN-RN
- 22 hours ago
- 3 min read
What is surgical smoke?
Surgical smoke is common in the operating room (OR). Cauterizing and coagulation devices, laser devices, and energy-based devices used during procedures create smoke by using thermal energy to cut tissue, while decreasing bleeding and expediting procedure time. They are used by the surgical team to assist in performing procedures. Surgical smoke has been noticed as a health hazard to OR staff and patients. Implementing measures such as smoke evacuation systems, ensuring proper air ventilation in the OR, and using proper personal protective equipment (PPE) helps reduce exposure. The Association of PeriOperative Nurses (AORN) is leading efforts to make ORs across the nation smoke-free. Currently, 20 states have enacted surgical smoke evacuation legislation.
Why is surgical smoke dangerous?
Surgical smoke contains harmful byproducts, chemicals, and toxins. According to research, some viruses, such as HPV, can be transmitted through surgical smoke. Individuals in the OR who are exposed to surgical smoke include the patient, surgeon, anesthesiologist, scrub staff, and the nurse. One study found that surgeons had HPV cells in their nasal epithelium after several years of exposure to surgical smoke, compared to physicians who did not have surgical smoke exposure. Other adverse effects of exposure to surgical smoke include headaches, dry eyes, coughing, respiratory disease, and cancer.
Surgical smoke can also be compared to cigarette smoke in terms of harmfulness. Carcinogens and formaldehyde are also found in surgical smoke. Research confirms that the amount of smoke formed from a laser of 1 gram of tissue is equivalent to smoking three unfiltered cigarettes. Surgical staff performing multiple surgeries tend to stack up occupational health damage if proper protocols are not in place.
Why are staff hesitant to recognize the dangers of surgical smoke?
Although surgical smoke has raised concern in the past, research over the last several years has begun to provide evidence of its dangers. However, educational material may be limited in some ORs. Older OR management may not emphasize limiting surgical smoke exposure, as they have become complacent with the "way we have always done things, and it has never been a known problem." Barriers to using smoke evacuation devices include the bulkiness of the product, the loud noise created by the smoke evacuation machine, and the consideration that some cases are not long and the smoke exposure time is insignificant in the staff members' opinion. However, over time, minutes of smoke exposure can add up to hours quickly.
How can we reduce surgical smoke in the OR?
The first step in reducing surgical smoke exposure in the OR is to educate surgeons and staff regarding the dangers of surgical smoke exposure. Smoke evacuator products and filtering devices have been created for the purpose of reducing surgical smoke exposure for OR staff and patients. In-services on this type of equipment are essential in educating staff on the risks of surgical smoke and how it can be reduced. Certain masks should be worn to help reduce exposure as well. Discussion of smoke exposure before the start of the case, and methods to be taken to reduce smoke exposure during the case, is essential to the well-being of patients and OR staff members.
Benaim EH, Jaspers I. Surgical smoke and its components, effects, and mitigation: a contemporary review. Toxicol Sci. 2024 Mar 26;198(2):157-168. doi: 10.1093/toxsci/kfae005. PMID: 38243717; PMCID: PMC10964745.
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