The Occupational Safety and Health Act of 1970 requires employers to maintain “an environment that is free from recognizable hazards that are causing or likely to cause death or serious harm to employees.”

Poor air quality is recognized as a critical environmental health hazard both indoors and out. Indeed, many state and municipal regulators require employers to routinely monitor and measure air quality in order to protect humans and the environment from harmful air pollution.

Despite the known fact that perioperative environments contain surgical plume which may harbor toxins, including viruses, bacteria, blood particles, cancer cells, inorganic gases such as carbon monoxide, it has not been determined by regulatory agencies that this constitutes a potentially unsafe environment for patients or OR personnel, and standards have not been set for unacceptable levels of air pollution in operating rooms. As a result, surgical staff face exposure to potentially dangerous concentrations of surgical plume on a regular basis.

Although instruments, methods, techniques and tools to test air quality and evaluate air emissions have made it possible to determine the composition and sources of air pollution, surgical staff still rely mainly on odor as a means of detecting the presence of airborne pollutants.

According to a study by Hill et. al. cited in a recent AORN Journal article, a person would need to smoke the equivalent of 27 to 30 unfiltered cigarettes on a daily basis to equal the passive air pollution mutagenicity generated by surgical smoke. Given this degree of toxicity, it seems remiss that there is as yet no requirement or protocol for measuring, monitoring or quantifying environmental air pollution in surgical operating rooms and no level specified as unsafe for patients or surgical staff to breathe.

AORN’s new “Guideline for Surgical Smoke Safety,” which is slated to be released in early 2017, will provide guidance on surgical smoke safety precautions and will offer recommendations for establishing and maintaining a safe environment for patients and OR team members. AORN emphasizes a multi-disciplinary approach that draws on the expertise and experience of perioperative RNs, surgeons, scrub personnel, infection prevention specialists, and materials managers to determine whether their institution’s smoke prevention equipment, technology and smoke evacuation policies and procedures meet designated criteria.

The forthcoming guidelines urge surgical facility managers to consider use of alternative devices that generate less surgical smoke, such as bipolar and ultrasonic instruments and to consider the availability of respiratory protection against surgical smoke. However, the AORN guidelines point to smoke evacuation as the first line of protection against the dangers of surgical smoke.


Guideline for Surgical Smoke Safety: Guideline First Look

By Carina Stanton, Contributing Editor

AORN Journal,

October 2016, Volume 104, No 4


United States Department of Labor

Evidence for exposure and harmful effects of diathermy plumes (surgical smoke)

Prepared by the Health and Safety Laboratory for the Health and Safety Executive 2012

Evidence based literature review

Alan Beswick & Gareth Evans Health and Safety Laboratory


Occupational Safety and Health Administration

Safety and Health Topics