A recent study conducted at the Training and Research Hospital in Izmir, Turkey found that while doctors and nurses were mostly aware that their ORs lacked smoke evacuation systems (69.1%), they did not take effective personal safety precautions and rarely used special filtration masks.

This startling finding emerged from a study conducted by Arzu Ilce and Ganime Esra Yuzden (both of Abant Izzet Baysal University, Bolu School of Health, Department of Nursing) and Meryem Yavuz van Giersbergen (of Ege University, Faculty of Nursing).


The research team conducted a descriptive statistical analysis of 81 doctors and nurses at the hospital and found that most participants were unaware that ordinary surgical masks did not protect them from surgical smoke. The study noted that it has been shown that surgical masks do not protect wearers from inhaling surgical smoke particles smaller than 5 μm (OSHA, 2015a).

At the time data was collected for the report, the Training and Research Hospital’s operating rooms had neither smoke evacuation systems, filters, wall suctions, nor protocols. “This finding would suggest a serious lack of information regarding the risks of and necessary precautions against surgical smoke on the part of those working in the operating room,” the report stated.

Among the reasons cited for not using smoke evacuation systems were: expense, noise, the belief that they disturb surgeons’ work, and a lack of knowledge about the harmful effects of surgical smoke. The study pointed to lack of knowledge and expense as the primary reasons. However, the article authors point out that smoke evacuation systems are not over-costly and one system is sufficient per operating room.

The study sample consisted of 45 nurses (scrubs and circulating nurses), and 36 doctors (surgeons and anesthetists) who participated voluntarily.

“Almost half of the doctors and nurses who participated in the study complained of headaches, watering eyes, coughs, burning throats, bad odors in the hair, and nausea; while a quarter complained of drowsiness, dizziness, and sneezing.”

The study’s participants reported experiencing a broad range of complaints due to surgical smoke, such as: headache (nurses: 48.9%, doctors: 58.3%); watering of the eyes (nurses: 40.0%, doctors: 41.7%); cough (nurses: 48.9%, doctors: 27.8%); throat burning cough (nurses: 40.0%, doctors: 38.9%), smell absorbed in the hair (nurses: 42.2%, doctors: 36.1%), nausea (nurses: 44.4%, doctors: 30.6%), drowsiness (nurses: 28.9%, doctors: 24.9%), dizziness (nurses: 28.9%, doctors: 22.2%), and sneezing (nurses: 24.4%, doctors: 22.2%).

“Although there were no occurrences of HIV or hepatitis in the current study, [the researchers] did identify occurrences of complaints such as respiratory infections, rhinitis, conjunctivitis, dermatitis, and respiratory problems.”

The report noted that surgical smoke can cause a variety of diseases including acute or chronic respiratory tract infection, hypoxia, eye irritations, headache, nausea, vomiting, fatigue, cardiovascular failure, hepatitis, cancer, in addition to nervous agitation (Dirimeşe, 2013). Moreover, HPV, HIV, tuberculosis, hepatitis B and C viruses can spread into the air within surgical smoke (Brüske-Hohlfeld et al., 2008), and studies indicate that those working in operating rooms can be exposed to infectious disease due to surgical smoke (Mowbray, Ansell, Warren, Wall, & Torkington, 2013; Ulmer, 2008). What’s more, surgical smoke includes chemical as well as biological hazards (Jones, Pierre, Nicoud, Stain, & Melvin, 2006). For example, it contains toxic gases which could have cytotoxic and mutagenic effects.


The report’s authors concluded that in order to minimize exposure to surgical smoke, ULPA filters and smoke evacuation systems should be used as recommended by the Association of periOperative Registered Nurses (AORN), protective personal equipment should be worn, procedures and standards determined, and records kept (AORN, 2015).

Furthermore, those working in operating rooms should be informed about the risks associated with surgical smoke, education programs should be developed, protocols implemented, and information disseminated about existing protocols and precautions that can be taken.


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Reference:  The examination of problems experienced by nurses and doctors associated with exposure to surgical smoke and the necessary precautions

By Arzu Ilce, Ganime Esra Yuzden, and Meryem Yavuz van Giersbergen

Arzu Ilce, Associate Professor, Abant Izzet Baysal University, Bolu School of Health, Department of Nursing, Bolu, Turkey

Ganime Esra Yuzden, Assistant, Abant Izzet Baysal University, Bolu School of Health, Department of Nursing, Bolu, Turkey


Meryem Yavuz van Giersbergen, Professor, Ege University, Faculty of Nursing, Department of Surgical Nursing, Izmir, Turkey