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Fighting for Smoke-Free ORs
How a grassroots effort to evacuate surgical plume is gaining momentum.
Natalie Hope McDonald | Contributing Editor
Publish Date: October 18, 2022   |  Tags:   Staff Safety Regulatory Affairs COVID-19
OR Smoke
DANGER IN THE AIR In the U.S. alone, an estimated 500,000 healthcare workers are exposed to surgical smoke each year.

When Illinois Governor J.B. Pritzker signed into law last year a measure that required hospitals and ambulatory surgery centers to eliminate surgical smoke, it was a big win for the nurses and other safety professionals who had been advocating for change for more than 30 years.

“In 1981, I gave my very first lecture about the hazards of smoke plume,” says Penny Smalley, RN, CMLSO, an independent nurse consultant and director of education and regulatory affairs for the International Council on Surgical Plume (ICSP). “I was involved with one of the first laser systems installed in a medical clinic, and there was no information or educational resources at the time about the hazards.”

Ever since lasers and electrocautery devices became mainstream surgical tools, the question of how the resulting surgical plume impacted people would be debated. Advocates like Ms. Smalley have been working toward educating both healthcare administrators and state legislators about why the issue is as important as ever. “The noxious smoke that results from surgery is disgusting and uncomfortable,” she says. It’s also considered one of the top five hazards in the OR today, prompting eight states — Georgia, Rhode Island, Colorado, Kentucky, Oregon, Washington, Arizona and Illinois — to pass laws requiring surgical teams to use evacuation devices during smoke-generating cases.

The grassroots effort behind this initiative, led by the Association of periOperative Registered Nurses (AORN), is pushing to get similar legislation passed in all 50 states — and momentum seems to be growing. According to AORN, the average daily impact of surgical smoke to a surgical team is the equivalent of inhaling up to 30 unfiltered cigarettes. In the U.S. alone, an estimated 500,000 healthcare workers are exposed to surgical smoke each year, and perioperative nurses report twice as many respiratory issues compared to the general population. 

Rebecca Vortman, DNP, RN, CNOR, an assistant clinical professor at the University of Illinois Chicago College of Nursing, has been instrumental in conducting important research into surgical plume. Dr. Vortman calls on healthcare providers and state leaders to require mitigation of hazardous smoke plume, which can contain E.coli, MRSA, HPV, hepatitis viruses and HIV. Other potential hazards, including COVID-19 variants, as well as gases such as benzene, toluene, carbon monoxide, formaldehyde and hydrogen cyanide, can pose serious health risks.

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