Score! Surgical Smoke Evacuation Mandates Now the Law in 20 U.S. States

North Carolina and Delaware act to relieve OR teams from breathing toxic intraoperative plume.

The movement to remove toxic surgical smoke from the nation’s ORs has reached another milestone, as 20 states have now passed laws that mandate usage of smoke evacuation systems for every plume-generating procedure that takes place in their surgical facilities.

The latest states to join the surgical smoke evacuation movement came on board this summer: North Carolina and Delaware.

Two new success stories

North Carolina became state No. 19 as Gov. Josh Stein signed HB 67, an omnibus healthcare workforce reforms bill that included surgical smoke evacuation language, into law on July 1. Facilities in the Tar Heel State must adopt and implement policies to filter and evacuate surgical smoke during smoke-generating procedures as of Jan. 1, 2026.

In March, Rep. Carla Cunningham, an RN serving in the North Carolina House, introduced HB 390, which rapidly moved through the House and was approved unanimously on Apr. 16. That bill was then sent to the Senate and assigned to the Senate Health Committee. By late May, the committee amended HB 67 to include the surgical smoke language from HB 390.

Jennifer Pennock, MS, associate director of government affairs for the Association of periOperative Registered Nurses (AORN), has worked tirelessly to help secure passage of state-level smoke evacuation laws over the last seven years. She says the North Carolina law is the result of a four-year-plus collaboration between AORN and the North Carolina Nurses Association (NCNA). “NCNA’s leadership and AORN’s grassroots support were key to getting this legislation enacted with overwhelming bipartisan support,” she says. “AORN is excited to help members implement and comply with this new law.”

Delaware became the 20th state on Aug. 25 as Gov. Matt Meyer signed HB 173 into law. The law requires hospitals and freestanding surgical centers to adopt and implement policies that require the use of a smoke evacuation system during any surgical procedure that is likely to generate surgical smoke. Delaware’s Division of Health Care Quality (DHQC) is tasked with enforcing the new law, which goes into effect on Apr. 1, 2026.

The Delaware Nurses Association worked to get the bill introduced by Delaware House Speaker Rep. Melissa Minor-Brown on May 20. On June 24, the bill was heard in the House Health & Human Development Committee, at which time the DHQC’s enforcement role was clarified.

Ms. Pennock notes that the North Carolina and Delaware bills were led by their respective state nurses associations. “It was because of their leadership and statewide reputations as nurse advocates that these bills were passed,” she says.

Much more work to do

As of mid-September, the list of states that have mandated surgical smoke evacuation by law now consists of these 20: Arizona, California, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Minnesota, Missouri, New Jersey, New York, North Carolina, Ohio, Oregon, Rhode Island, Virginia, Washington and West Virginia.

While this incredible amount of progress has been made across the country, AORN, state-level associations, perioperative professionals and other stakeholders continue the hard work, year upon year, of bringing the remaining 30 U.S. states on board with their own smoke evacuation laws.

This year is no exception. Bills have been under consideration by legislators, but not yet passed into law, in nine additional states in 2025: Arkansas, Florida, Hawaii, Massachusetts, Michigan, Oklahoma, Pennsylvania, South Carolina and Texas.

As of mid-September, Ms. Pennock says the bills in Massachusetts, Michigan, Pennsylvania and South Carolina are moving forward and could possibly carry over into 2026.

What does the playbook look like for 2026, in addition to those four states? “We are currently also anticipating smoke evacuation legislation in 2026 in Florida, Oklahoma, Iowa and Wisconsin,” says Ms. Pennock.

“The Legislatures in Arkansas and Texas do not meet for regular sessions in 2026 so they will not be considering legislation.”

Smoke evacuation laws have often passed with bipartisan approval over the last seven years. This year’s political landscape, however, appears more polarized than ever. We asked Ms. Pennock if she believes that polarization has impacted efforts to move smoke evacuation bills forward in various statehouses this year.

“Politics often comes into play when surgical smoke bills do not progress,” she says, while not specifying that 2025 is different than any other year in terms of the smoke movement’s efforts. “Often, the legislature is focused on other issues entirely unrelated to health care or the OR but those issues keep the smoke bills from moving forward.”

Despite only two states coming on board so far this year, Ms. Pennock takes the long view and preaches resilience and resolve. She notes that even in many states where bills have not progressed, legislators are now aware of the danger of surgical smoke and the need to evacuate it for the safety of those who work in ORs. That wasn’t the case 10 years ago.

“Over the years, surgical smoke evacuation legislation has been considered in approximately 35 states, and each year we’ve had eight to 12 states with bills,” she says. “So it’s not so much a matter of getting attention to this issue anymore.”

What you can do

If you work in one of the 30 states that have not passed a surgical smoke evacuation law — or even one of the 20 that have — you can help.

“I think a key call to action at this time would be for folks everywhere to utilize the Center of Excellence Go Clear Program to take their facility smoke-free, whether there’s a state law or not,” says Ms. Pennock. “Our best advocates come from this program. They can speak to the benefits of working in a smoke-free facility and tell legislators how they went surgical smoke-free.”

She adds that AORN members can join monthly National Legislative Forum calls to receive updates and advice from AORN Government Affairs and their colleagues across the country who have engaged in similar smoke evacuation advocacy efforts. OSM