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Surgical Smoke Exposure and Ambulatory Surgery Centers


Helen Larios, MBA, MSN, RN, project director-clinical, Standards and Survey Methods 

During my perioperative career as an operating room nurse, often in the scrub or assistant roles, the potential dangers of surgical smoke exposure were a real concern. 

All of us wore a mask in the operating room, but during some long procedures, I remember my eyes watering and trying to hold back the urge to cough as the smoke accumulated in the sterile field while the surgeon cauterized a patient’s tissues.  My colleagues and I would often switch room assignments to help each other minimize our exposures to surgical smoke.  

Burning eyes, a sore throat and headaches are known consequences of surgical smoke exposure. The degree of danger from surgical smoke exposure has yet to be determined, although research has found that surgical smoke contains both cancer-causing gaseous compounds and small particulate matter that are easily inhaled.  The effects of long-term exposure to surgical smoke – and the chemicals and carcinogens stemming from that smoke – remain a concern to me and many of my colleagues today.  

Potential for Increased Risk 

Surgical staff in ambulatory surgery centers (ASCs) can be at increased risk of surgical smoke exposure from cauterization instruments and lasers because these settings sometimes lack the necessary resources to purchase smoke evacuators. This leaves staff and surgeons exposed to the dangers surgical smoke often poses.  

When an ASC does not provide its staff with the necessary equipment to evacuate the smoke, staff will simply use regular suction tubing and a suction tip in place of a dedicated smoke evacuation device to evacuate the smoke.  Unfortunately, while trying to use that same suction to keep the sterile field clear of any bodily fluids and free of surgical smoke billowing from the cautery device, surgical staff quickly find that evacuating the smoke becomes less of a priority.  Often, I would have surgeons tell me that visualization of the field is the highest priority and to forget about the smoke.

While The Joint Commission is not currently considering new standards that address surgical smoke, we do want to help ambulatory care organizations in their efforts to learn more about this safety concern and to provide safety tips and strategies.  

Supporting a Culture Change
As a past perioperative educator, I can attest to how challenging a culture change can be for everyone involved.  Addressing surgical smoke exposure and its risk associated within ASCs no doubt has its challenges. To bring forth change, but more importantly to sustain it, will need buy-in from leadership, surgeons and staff alike.  

What ASCs can do moving forward:

  • provide a business case for the purchase of smoke evacuators
  • benchmark with other ASCs in the area for best practices, costs, policies, education and implementation strategies
  • bring in vendors for smoke evacuator trials and in-services to educate staff and surgeons
  • identify staff and surgeon/anesthesia champions to share evidence, literature and legislation on surgical smoke with your administration
  • attend conferences and webinars to learn more about the risks associated with exposure to surgical smoke
  • discuss the need for a surgical smoke evacuator (if available) during a pre-op huddle or briefings with your surgical team

Because surgical smoke exposes the surgical team and patients to potential dangers, efforts should be made to reduce or eliminate smoke from the operating room.   

Please feel free to me with your questions. 

Helen Larios MBA, MSN, RN, is project director-clinical, Department of Standards and Survey Methods. Larios received Lean and Six Sigma and high reliability organizational training while employed at the Advocate Good Samaritan Hospital. Prior to joining The Joint Commission, Larios held various managerial roles throughout surgical services with a specialized focus in orthopedics and spine in both acute inpatient and outpatient settings. Larios also served as a clinical mentor for Elmhurst College’s Nursing Master’s level program. Larios has over 15 years of clinical nursing experience that includes quality improvement, outcomes and project management.