Your State Requires Smoke Evacuation: Now What?

States See Steady Rise in Surgical Smoke Laws

With 14 states now requiring surgical smoke evacuation, including three that passed laws this summer, there’s steady momentum to make surgical smoke evacuation mandatory, says AORN Associate Director of Government Affairs Jennifer Pennock.

Legislators have become increasingly aware of surgical smoke hazards and now recognize smoke evacuation as the most effective prevention tool. She says this stems from research presented by surgical safety advocates and firsthand accounts linking surgical smoke to cancer and respiratory issues. Both underscore that masks alone aren’t adequate to protect healthcare teams or patients in the OR.

Smoke-Free: From Advocacy to Practice

While Pennock has been coordinating smoke safety on the legislative front, AORN’s Emily Jones, MSN, RN, CNOR, NPD-BC and Hannah Campbell, BA, MS, CSM, continue to work on the clinical and logistical fronts with practical tools to help organizations take the next steps to make smoke-free ORs a reality.

Implementing new practices in the surgical suite can be a challenge. That’s why nurse leaders like Maria Fezza, MPA, MSN, RN, CNOR, and Mary Dobbie, MPA, MS, RN, CNOR, at NYU Langone Health have been sharing their secrets on how to write a solid facility policy and collaborate with surgeons and staff to sustain system-wide smoke evacuation in daily practice.

What do you need to do after your state passes smoke-free surgical safety laws?

Periop Today recently asked these smoke-evacuation experts your pressing questions to help you achieve a smoke-free workplace — whether it’s required by law or not.

Question #1: Where should we start our smoke-free journey?

Jones: Start with reviewing AORN’s Guideline for Surgical Smoke Safety in the Guidelines for Perioperative Practice to educate yourself and understand the research you’ll need to share to win over OR staff and surgeons on the hazards of surgical smoke.

A good one-page reference to get started is this concise list of highlighted literature from the guideline. We’ve also created posters and other visuals to educate and remind team members about the importance of safely managing surgical smoke, which can all be found in the Management of Surgical Smoke Tool Kit.

Next, get familiar with the tools available to help achieve smoke-free ORs, including:

• Key takeaways (pdf) to understand key practice recommendations
• Gap analysis tools to measure team knowledge gaps on smoke hazards and evacuation practices
• Facility policy/procedure template to personalize smoke evacuation requirements to individual facility needs
• Audit tool to track smoke evacuation compliance

At AORN’s Guidelines Workshops in six cities this fall, guideline authors plan to discuss the tools and approaches for implementing smoke-free programs.

Campbell: Start rallying team participation by earning the Go Clear Award^TM offered through AORN’s Center of Excellence in Surgical Safety: Smoke Evacuation.

Staff education constitutes a major piece of earning the Go Clear Award, so the free program provides access to intraprofessional surgical smoke safety education (email us and receive a log-in with free registration) — no need to create your own from scratch. And it includes free tools and tips.

To date, just over 300 facilities of all sizes have completed the program and earned the Go Clear Award; more than 1,000 more facilities are working toward it.

Question #2: Do I need a specific policy for smoke evacuation? What should it look like?

Pennock: Most states that passed legislation require facilities to adopt and implement their own policies and are not prescriptive about what must be included.

For nurses shaping a new facility policy, be clear that surgical smoke evacuation equipment must be used for all planned procedures likely to generate surgical smoke. You also must include a staff education component and instructions to address any noncompliance.

Jones: While not a regulatory requirement, a surgical smoke safety facility policy can be formatted to align with the NIOSH/CDC Hierarchy of Controls if your facility prefers that approach. We created this visual aid to help teams include language in their policy that spells out how to follow the Hierarchy of Controls for Surgical Smoke (pdf).

Question #3: What can I do if my facility doesn’t follow its own smoke evacuation policy?

Pennock: AORN empowers nurses to advocate for smoke evacuation. We encourage nurses to work with their teams to change practices — reminding everyone it’s for their own health and safety and that of their patients. Read more about  addressing smoke evacuation compliance challenges.

Other options may involve informing the relevant state authority — typically the state hospital and ambulatory surgery center licensing body, or the state's occupational health and safety agency.

Find the  smoke evacuation enforcement authority (pdf) (AORN member-only access) in your state.

Question #4: How should teams approach facility policy decisions for procedures that prove more challenging to evacuate surgical smoke?

Jones: Certain surgeries, such as those in very tight spaces, can make smoke evacuation equipment more difficult to use. We encourage open team dialogue to identify the approach that achieves surgical smoke evacuation and does not interrupt the surgeon’s ability to perform the procedure. There could be multiple solutions — it’s a team decision.

To help teams work through surgical smoke evacuation challenges, we created the surgical smoke safety decision tool (pdf).

Question #5: How can I learn from other facilities who have found success with their smoke evacuation policy?

Fezza and Dobbie: At NYU Langone Health in New York City, we began our smoke-free journey across 44 ORs and other procedural spaces in December 2016 (six years before the smoke evacuation law passed in NY). We chronicled our journey in this AORN Journal article.

When we created our first smoke evacuation policy, here is what helped us get it approved and followed:

• Used the AORN smoke evacuation policy template.
• Involved all disciplines.
• Worked with surgeons to determine specific equipment needs and talk through obstacles.
• Included language requiring re-training to address gaps in competency and ensure compliance.
• Re-evaluated our policy once the NY law passed to make sure we were complying with state regulations.

Question #6: Does AORN offer in-person training to help my smoke-free implementation team get started?

Jones: The Guidelines Workshops will give teams the chance to network and learn with the experts and each other about key safety practices, including how to implement surgical smoke management solutions. As author of the Guideline for Surgical Smoke Safety, I value the opportunity to talk with our members about how the Guidelines can work to improve patient care and worker safety.