5 Facts to Make You a Surgical Smoke Advocate

Mary Ogg, MSN, RN, CNOR
AORN Senior Perioperative Practice Specialist



Over 150 hazardous chemicals have been identified in surgical smoke


Many of us have shared anecdotal stories about persistent respiratory illnesses or allergies that plague us. I’ve wondered for years if my chronic bouts of laryngitis could be linked to my 20+ years of exposure to surgical smoke.

Today the strong collection of literature out there on the dangers of surgical smoke tells us that we’re probably right; that many perioperative RNs, doctors and other surgical team members have been harmed by exposure to surgical smoke. The research is also helping us understand how to protect our OR environment from the dangers of surgical smoke, yet many face this toxic harm every day because their facilities have not yet implemented safe surgical smoke practices. These safety practices include correctly using smoke evacuation technologies to adequately protect personnel (and patients) from exposure.

Perioperative nurses have the power to raise awareness and protect OR team members and patients from toxic surgical smoke. We can share the evidence to turn the tide. Here are five research findings that made me a believer in the tangible dangers of surgical smoke:

  1. Inhaling the smoke produced when using an electrosurgery device to vaporize one gram of tissue is like smoking 6 unfiltered cigarettes in 15 minutes.

  2. Just being passively exposed to 1 day of surgical smoke in the OR exposes nurses to an equivalent mutagenicity of smoking 27 to 30 unfiltered cigarettes a day.

  3. Long-term exposure to polycyclic aromatic hydrocarbons (PAHs) such as benzene, along with particles and volatile organic compounds found in electrocautery smoke, may have synergistic and additive effects.

  4. Even when researchers found the levels of benzene, xylene, ozone, and other toxins in surgical smoke measured within permissible exposure limits, they cautioned that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Adverse health effects of benzene exposure include respiratory irritation, dizziness, headache, nausea, and fatigue.

  5. Infective and malignant cells found in the smoke plume of surgical smoke are sufficiently small enough to breathe in.

Now is the time for action to clear our ORs of toxic surgical smoke. There is strong evidence available to understand the dangers of surgical smoke, as well as technologies and evidence-based practices ready to implement.

With this abundance of evidence, AORN has taken a strong stand in support of surgical smoke safety. Read our guideline on surgical smoke safety (I am the lead author), and learn more about the AORN Go Clear Award™ to help perioperative providers implement surgical smoke safety practices.