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The Top 3 Dangers of Surgical Smoke

09.02.2021 • Industry News

Michelle Lemmons, RN, BSN, PHN, CNOR, CCSVP
Clinical Educator, OR
Key Surgical

Surgical smoke in the operating room has been a hot topic (pun intended) and for a good reason – there are very real life-threatening risks associated with plume. For years surgical smoke has been accepted as ‘just a part of working in the O.R.’ but as of 2020 there are now 5 states (Colorado, Kentucky, Illinois, Oregon, and Rhode Island) that have passed legislation to evacuate surgical smoke in the operating room; helping to shed the light on the severity of exposure to this procedural by-product. With 9 more states following suit, advocacy is certainly improving but we need to continue to drive awareness of the dangers of surgical smoke. Here are the top 3 dangers of smoke in your O.R.:
  1. Breathing in surgical smoke is as dangerous as smoking 30 unfiltered cigarettes ​​​​​Research reveals that perioperative nurses report 2x the number of respiratory issues compared to the general population.
  2. Surgical smoke contains over 150 different chemicals as well as cells, bacteria, and viruses. Yep. Over 150. Among these chemicals are benzene (categorized in 2012 by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen, meaning exposure to benzene has a high potential of causing cancer in humans)1, hydrogen cyanide (interferes with the normal use of oxygen by nearly every organ of the body) 2, and formaldehyde (watery eyes; burning sensations in the eyes, nose, and throat; coughing; wheezing; nausea; and skin irritation)3. Carcinogenic and mutagenic cells as well as viruses like the HPV virus have also been shown to be present in samples of surgical smoke. There has not been a study showing that COVID-19 can be transmitted in surgical smoke however many regulatory bodies suggest that staff take precautions against surgical smoke because of the known ability for virus transmission.
  3. Surgical smoke is not always visible. This might not sound like a danger but often the hardest thing to ‘believe’ are the things that are not visible. Studies show that after just 5 minutes of ESU use, the particle count per cubic foot in the O.R. increased from 60,000 to over 1 million. Further, surgical smoke can linger in the operating room for up to 20 minutes, traveling at rates of 40 MPH. Quite the invisible aggressor if you ask me.4

As a surgical staff member, a patient, or a patient advocate, knowing about these dangers is important but it’s what you DO with this information that will create change. Take action today to eliminate surgical smoke in your O.R. by providing education about surgical smoke hazards. Use a smoke evacuator wherever/whenever surgical smoke is produced and get involved in surgical smoke legislation. Reach out to your state representative to find out how to get started or use the ‘Go Clear’ resource available through AORN.


1. https://www.cancer.org/cancer/cancer-causes/benzene.html
2. https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750038.html
3. https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/formaldehyde/formaldehyde-fact-sheet
4. https://www.aorn.org/-/media/aorn/guidelines/tool-kits/management-of-surgical-smoke/part_ii_the_hazards_of_surgical_smoke_2018.pptx?la=en&hash=CEA8C7083EDD793C98DC15BABB87AEA7