4 Approaches to Make Smoke Evacuation the Standard of Care

The smell of surgical smoke once permeated the air of ORs, hallways and lounges at Shriners Hospitals for Children in Salt Lake City.

Today, the air in every surgical setting within the hospital smells clean, and healthy, according to Steven Grant, BSN, RN, CNOR, perioperative charge nurse and team leader of the hospital’s Go Clear Surgical Smoke-Free Program.

After attending an education session at an AORN conference three years ago on AORN’s Go Clear Surgical Smoke-Free Recognition program, Grant and three of his nurse colleagues decided the time was right to make their ORs smoke free.

Through persistence and patience with education, trialing smoke evacuation equipment, and securing buy-in from physicians and administrators, they have successfully implemented a policy that requires every surgical case to be smoke-free.

Shriners Hospital is the first and only health care facility in the state of Utah to be smoke-free. The facility recently joined a handful of hospitals across the country who have earned AORN’s Go Clear Gold Level Award designation for becoming surgical smoke-free.

While the road was not always easy, Grant says becoming smoke-free is possible and imperative for staff and patients. Here are four approaches that helped his hospital find smoke evacuation success: 

1. Keep Trying

   Grant’s team started by implementing a soft launch education plan on the dangers of surgical smoke with educational posters displayed at scrub sinks and through conversation with perioperative team colleagues. This approach was gaining traction among nurses and surgical technology staff but was slow to engage physicians.

   To ramp up momentum, the Go Clear team prepared a detailed argument to their chief of staff for becoming smoke-free. “She instantly agreed this needed to happen and gave us the green light to require team education with the Go Clear education modules. We were also given funding to trial smoke evacuation equipment and offer incentives to surgical team members who completed the modules.”

   Grant and his team created a poster to display each team member who completed the Go Clear education modules, and this fueled a competition among team members to complete the modules.

   “The competition became the most successful incentive to spread smoke-free buy-in,” Grant shares. “As more and more surgical team members engaged in the module training, the conversation would come up in the OR and awareness definitely drove a change in mindset about the need to address surgical smoke safety.”



2. Find the Right Fit for Smoke Evacuation Equipment

   Grant and his team introduced several smoke evacuation products but got pushback from surgeons arguing their visibility was compromised and refused to evacuate smoke.

   “We kept doing our research and found a smoke evacuation system design with tubing that can be extended down or pushed back so the tip of the Bovie can be seen and the surgeons liked this,” Grant says.

   They received widespread surgeon buy-in for the single smoke evacuation system and are now working with their supply chain team to standardize custom packs and other aspects of managing smoke evacuation supplies.



3. Be Consistent

   Using the policy template from the Go Clear program, Grant and his team tailored a policy requiring smoke evacuation in every OR. “We agreed we had to do this all the way—if anyone was given a pass on evacuating smoke, we knew it would be hard to implement.”



4. Promote Your Success

   Being the only hospital in Utah to achieve surgical smoke-free ORs has put Shriners Hospital for Children in Salt Lake City in the spotlight, not only within the Shriners health system but among other hospital systems in Utah.

   The hospital’s marketing and communications team is also using their surgical smoke-free status as a promotion tool to share the hospital’s focus on providing a safe environment for surgical care to protect staff and patients.

   “Every step in this process has been very empowering, this is a real sense of accomplishment, we feel extraordinarily fortunate that our facility would support us in this movement,” Grant shares.

His one piece of advice to other perioperative nurses trying to advance surgical smoke evacuation is to express a sense of urgency about the well-documented dangers associated with surgical smoke. “Twenty-three years ago, NIOSH reported the health risks associated with surgical smoke. With the improvements to product design, and AORN’s comprehensive resources the time is right to strongly advocate for a smoke-free environment. We hope our success, and the success of our colleagues who have achieved smoke-free ORs inspires others to see this is an achievable and important goal.”

Additional Resources

Learn more about AORN’s Go Clear Smoke-Free Recognition program.

Free Resources for Members

Manage and remove surgical smoke in your OR with these free, members-only resources:

• Management of Surgical Smoke tool kit
• Guideline Implementation: Surgical Smoke Safety (1.2 CHs)
• Operation Clean Air: Implementing a Surgical Smoke Evacuation Program (1.4 CHs)
• Back to Basics: Protection from Surgical Smoke (1.2 CHs)
• Surgical Smoke: Putting the Pieces Together to Become Smoke‐Free (1.6 CHs)
• Up in Smoke: New Guideline Highlights (1 CH)