3 Ways to Strengthen Your Case for Smoke Evacuation

Education is the first step to shift attitudes and actions toward consistent smoke evacuation in all procedural areas. A clear policy on smoke evacuation practices serves to standardize these actions, preventing all members of the surgical team and the patient from exposure to toxic, pathogenic, and carcinogenic surgical smoke.

But what do nurses do when the policy isn’t followed, and surgical smoke is allowed to contaminate their ORs?

Report it. That’s the advice of Deb Carter, RN, in Oregon. After pushback from certain surgeons who refused to evacuate surgical smoke in the ORs she worked in, despite a policy recommending smoke evacuation and extensive education on the reasons why, Carter reported it to her state Occupational Safety and Health Administration (OSHA) through an anonymous online form. Twenty-four hours later she received a response from OSHA, and her facility was required to respond to her complaint.

She encourages more nurses to do the same. “Nurses are not being squeaky wheels. When large numbers of us speak out, our facilities will have to take action to protect us.”

Speaking Up

Reporting occupational smoke exposure can be done at multiple levels. Carter suggests these three avenues nurses should take to strengthen their case for smoke evacuation:

1. Establish Smoke Evacuation Policy and Education
   Carter learned that following a filed complaint, OSHA will want to see a facility’s policy on smoke evacuation and understand if a knowledge deficit is the source of occupational exposure. Even if a policy only recommends smoke evacuation, having a formal policy in place and having documented education on surgical smoke risks will help your case, Carter suggests.

2. Report to Your Employee Health Office
Most hospitals have an employee health office where occupational injury can be reported. This is the first place to notify your facility formally about your exposure to surgical smoke, Carter notes. “If you are experiencing health effects from surgical smoke, bring documentation from your personal physician to add to your report.”

3. File a Complaint with State or Federal OSHA
Certain states have state-based OSHA offices, while other states defer to federal OSHA. A quick Google search will help you find out which is the case in your state. In Carter’s case, Oregon has a state OSHA office. From the Oregon OSHA website, Carter simply clicked on “File a Complaint” and filled out requested information, including name of facility, contact (such as a director) and specifics related to her exposure event(s). The nurse complaining can remain anonymous.

Being Heard

On the legislative front, when nurses lodge formal complaints with OSHA about exposure to surgical smoke, it helps advocates such as AORN by providing data to share with policymakers as they consider the scope of the problem and the need for legislation, notes Jennifer Pennock, senior manager of AORN Government Affairs. Often, OSHA responses to complaints fall short and do not ultimately result in consistent smoke evacuation in a facility. That is important information to share with policymakers as well.

Currently Pennock is working on behalf of AORN to push legislation requiring surgical smoke evacuation in Oregon and several other states. Similar bills have already become law in Rhode Island and Colorado.

“We are finding that the first response to our legislation from many folks is to ask if there been complaints to OSHA. If OSHA can say there have been complaints, this provides a stronger case for demonstrating a need for legislation,” Pennock says. She notes that NIOSH recommended smoke evacuation in 1996. “Without nurses raising concerns through available complaint processes, legislators may assume healthcare providers are following this recommendation.”

If nurses don’t speak up, Carter worries about the serious health effects of surgical smoke exposure that continue to impact perioperative nurses, as well as surgeons, including respiratory issues and even cancer. “Everyone needs to step up together, complain to their employer, employee health, and OSHA,” Carter stresses. “Rise up and shake the rafters, until then everyone outside of the OR will say surgical smoke is not a problem.”

Learn about AORN Government Affairs work with and explore resources through AORN’s Go Clear Award^TM Program to educate staff about the dangers of surgical smoke.

Free Resources for Members

Guideline Essentials: Ready-to-use, customizable templates and tools to implement the Guideline on surgical smoke.

AORN Journal CNE Articles

Guideline Implementation: Surgical Smoke Safety (1.2 CHs)
Operation Clean Air: Implementing a Surgical Smoke Evacuation Program (1.4 CHs)

Tool Kit: Management of Surgical Smoke