Surgical Smoke

Surgical smoke is a complex mixture of particulates, gases and chemical vapors. It is created by tools and instruments that generate intense heat and destroy tissue during use. They include: lasers, electrosurgical units, ultrasonic devices, and high speed burrs, drills and saws. Surgical smoke contains a variety of particles and hazardous combustion byproducts. Examples include:

  • Respirable and ultra-fine particulates that can contain living and dead cells, cell fragments including blood cells, viruses, bacteria, and other infectious materials.
  • Combustion products like Benzene, hydrogen cyanide, formaldehyde, carbon monoxide, and polyaromatic hydrocarbons (PAHs).

Exposure to these hazardous materials may have a wide range of health effects from irritation to potentially causing cancer or infections.

Overview

Each year, thousands of health care workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to hazardous smoke generated during surgical procedures that use lasers or electrosurgical devices. These devices are used in a variety of health care settings including hospital operating rooms, procedure rooms, ambulatory surgery centers, and outpatient clinics.

Surgical smoke may contain potentially hazardous materials such as benzene, hydrogen cyanide, formaldehyde, cellular material (including blood fragments), viruses and other infectious particles. The smoke has an unpleasant odor and contains hazardous chemicals. Some of these are known human carcinogens. At high concentrations, the smoke causes irritation of the eyes and upper respiratory tract and may create visual problems for the surgeon.

Exposure to surgical smoke can be decreased by using effective controls such as a local exhaust ventilation systems, commonly referred to as “smoke evacuation systems.”
Substitute House Bill (SHB) 1779 was passed by the Washington State Legislature and signed into law by Governor Inslee on March 7, 2022 to address surgical smoke hazards in hospitals and ambulatory surgical centers. The new law, RCW 49.17.500 and RCW 49.17.505, takes effect on January 1, 2024. For more information see the L&I Surgical Smoke Rulemaking page.

Getting Started

If there is a visible plume of smoke, there is significant hazard to the workers. Start by decreasing the exposure by using a smoke evacuation system to capture the smoke and remove it from the workplace. Provide your workers with safe work practices that provide specific processes and procedures that address the ventilation systems in use like set up, positioning, and operation. Train your workers on how to use and position the systems. Create programs that keep these systems working at acceptable levels of protection including installation, maintenance, and equipment testing. Refer to equipment manuals for specific information. Use respirators if other controls are not feasible or for back up.

Requirements & Policies

Hospitals and ambulatory surgery centers must have controls in place to decrease the risk of exposure to surgical smoke. Beginning January 1, 2024 (2025 for small rural hospitals) DOSH will begin enforcement of the law during onsite inspection of facilities licensed by Washington State Department of Health as hospitals and ambulatory surgery centers. At a minimum, this includes a review of facility surgical smoke policies.

For more information on rules or possible reimbursements, you can email surgicalsmokeinfo@lni.wa.gov.

Laws and Rules

Enforcement Policies

Reimbursement

Standards and Guidance from others

Training & Resources

Meeting Workplace Safety & Health Requirements

You can use these materials to meet specific requirements in L&I Safety & Health rules. You can use other materials as well.

Publications, Handouts, Checklists

Federal Agency Resources

Association of periOperative Registered Nurses Resources (AORN)