17 States Now Mandate Surgical Smoke Evacuation

That means 33 states still don’t... but your voice can make a difference.

More than one-third of U.S. states have now enacted legislation that requires the use of surgical smoke evacuation systems in their ORs. The newest states to come on board are neighbors: West Virginia and Virginia.

On Mar. 22, West Virginia’s Republican governor, Jim Justice, signed HB 4376 into law. Meanwhile, in Virginia, the commonwealth’s House and Senate passed identical bills: HB 763 and SB 537, respectively. Both were signed into law by Republican Gov. Glenn Youngkin on Mar. 28.

The Virginias have joined 15 other states to date that have passed similar smoke evacuation laws: Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio, Oregon, Rhode Island and Washington.

Yes, Virginia(s), there is a law

The new West Virginia law goes into effect on Jan. 1, 2025. It will require the state’s Office of the Inspector General to propose rules for legislative approval that will require a healthcare facility to utilize a smoke evacuation system during any procedure likely to generate surgical smoke. Any health facility subsequently in violation of the state’s surgical smoke evacuation requirement is subject to a fine of $1,000 to $5,000 per violation.

As in many states, it takes a dedicated legislator to work with advocates, gather support from colleagues and committees, and keep the bill moving through the laborious lawmaking process. In West Virginia, that champion was Republican Delegate Phil Mallow. “Delegate Mallow has championed the issue of surgical smoke evacuation since he first introduced legislation in 2022,” says Dawn Yost, MSN, RN, CNOR, CSSM, manager of surgical support services at WVU Medicine in Morgantown and West Virginia State Council Chair for the Association of periOperative Registered Nurses (AORN). “We are grateful for his advocacy and persistence and look forward to Jan. 1, 2025, when all facilities will need to evacuate surgical smoke.”

Virginia’s law, meanwhile, goes into effect on July 1, 2025, which gives surgical facilities in the state more than a year to prepare. Its development was a grassroots effort, as Janet Shortt, MHSA, BS, RN, CNOR, president of AORN Chapter 4702 in Richmond, engaged the Virginia Nurses Association about the importance of surgical smoke evacuation. The organization agreed and added surgical smoke evacuation legislation to its 2024 policy agenda.

Ms. Shortt offered a public comment on Virginia HB 763. “After 20 years in the OR, after three bouts of bronchitis and multiple upper respiratory infections, I was diagnosed with asthma,” she said. “I thought this odd as I was living a healthy lifestyle, working out five days a week and eating a healthy diet. I now have chronic asthma that requires inhalers.” She explained that the smoke within the OR aggravates her asthma and makes her eyes water.

Meanwhile, in fall 2023, AORN surveyed its members in Virginia to gauge the availability and usage of surgical smoke evacuation equipment in the state. The good news was that 94% of respondents said their facility had smoke evacuation equipment. The bad news was that only 26% said that surgical smoke was always evacuated during smoke-generating procedures.

TOXIC HAZE Surgical smoke contains harmful chemicals and lung-damaging particulate matter, and may also contain biohazardous materials such as viruses, bacteria, blood and potentially viable cancer cells.

These results helped drive home to legislators the necessity of a mandate to ensure that surgical smoke evacuation systems would not just be present at facilities but actually used for every smoke-generating surgery.

“On behalf of my perioperative colleagues across the state, I’m thrilled that we could make Virginia one of the next states to go surgical smoke-free,” said Ms. Shortt on the bill’s signing into law.

Doing the work

According to AORN, which has worked tirelessly in all 50 states to help advance smoke evacuation legislation, bills for the 2024 session currently remain under consideration by legislators in four additional states: Massachusetts, Minnesota, North Carolina and Pennsylvania.

• Massachusetts. AORN is currently working to get smoke evacuation language added as an amendment to a bill in the state Senate, says Jennifer Pennock, associate director of government affairs with AORN.

• Minnesota. HF 4011 and SF 3948 were introduced on Feb. 19. “The Minnesota legislation is proceeding and looks likely to pass,” Ms. Pennock told Outpatient Surgery Magazine on April 22. We’ll know soon either way, as Minnesota’s 2024 legislative session closes on May 21.

• North Carolina. As in Virginia, AORN has joined forces with the state nurses’ association to advance a bill. HB 650, passed by the N.C. House in 2023, is eligible for Senate approval this year. The N.C. legislature reconvened last month to begin a three-month session and there are hopes that the bill will be taken up by the Senate.

• Pennsylvania. Ms. Pennock says AORN is working to get a bipartisan bill introduced in the Pennsylvania House and enacted this year. The House bill would mirror the language of a bill that Democratic Sen. Katie Muth introduced in the state Senate last year.

A bill in Florida failed to pass this year, but Ms. Pennock says advocates will relaunch the effort for 2025. In Florida and other states where movements toward introducing bills are in various stages of development, Ms. Pennock’s message to smoke evacuation advocates is to never give up.

“It can be discouraging when you work hard to get a bill passed only to see the legislative session end without success,” Ms. Pennock tells Outpatient Surgery Magazine. “Just because your bill does not succeed this year does not mean it is without merit or without any chance of future passage. Often there are political reasons for a bill’s success or failure that have nothing to do with the content of the legislation and everything to do with the people in the legislative body. You will not be starting all over again with a new bill because you have already introduced the issue to the legislators and educated them on the hazards of surgical smoke.”

Adds Ms. Pennock, “ASC advocates are crucial to the success of these bills. If you are evacuating surgical smoke, your legislators can learn through your facility’s example that surgical smoke evacuation is best practice and protects the health and safety of OR staff and the state’s healthcare workforce.”

To get involved in surgical smoke evacuation advocacy in your state — or simply to arm yourself with resources to develop and promote smoke evacuation policies at your own individual facility — AORN encourages interested parties to visit AORN Government Affairs for more information. OSM

In Memoriam

Angela Hohn: An OR Nurse Who Made a Difference

SMOKE EVACUATION CHAMPIONS Deep into their effort to pass surgical smoke evacuation legislation in Georgia, Angela Hohn (left) and Brenda Ulmer posed for a photo together at the Georgia Council of periOperative Registered Nurses conference in 2021.  |  Photo courtesy of Brenda Ulmer

On Jan. 10, Angela Hohn, RN, BSN, BS, CNOR, FCN, a perioperative nurse in the Atlanta VA Health Care System, passed away at 66. She firmly believed that her decades of working in smoke-filled ORs led to her diagnosis of stage 4 non-small cell lung cancer, and she became a prominent advocate for a smoke evacuation mandate in the Peach State. Ms. Hohn’s testimony and presence was instrumental in the long and ultimately successful struggle to pass a smoke evacuation bill in Georgia, an achievement that occurred in 2022. Ms. Hohn graced our cover in March 2021, and you can read her story, as well as an inside look at efforts that eventually led to Georgia passing its smoke evacuation law, at osmag.net/AngelaHohn.

When Ms. Hohn began investigating the harmful effects of surgical smoke, she connected with perioperative nurse educator and AORN Past President Brenda C. Ulmer, RN, MN, CNOR, FAORN, who lived close by. The nurses became friends over the next three years as they worked to get the bill passed, and celebrated their success together when their goal was achieved. Ms. Ulmer shared the following essay, “Crisis to Advocacy: The Road Less Travelled,” with us in remembrance of Ms. Hohn:

**

In February 2020, a biopsy confirmed Angela Hohn had stage 4 non-small cell lung cancer. In spite of this devastating news, Angela started her journey from crisis to advocacy. The lung cancer diagnosis during a global pandemic launched Angela on the fight of her life — for her life. Treatment was solitary because of COVID, but during her plight, she determined she had a greater purpose: to share her story in the hopes of preventing more nurses from hearing such devastating news through advocating for evacuation of surgical smoke. That is how I met Angela.

In 2019, we started efforts to get surgical smoke legislation passed in Georgia. Angela reached out to offer her help and she remained one of our core group of advocates throughout the three years it took us to pass legislation. She never let her physical trials interfere with what we were doing.

Our first smoke bill was introduced in the 2020 legislative session. Although the bill never made it out of committee, we were granted Senate Study Committee hearings in fall 2020. Angela could not attend our first hearing but gave testimony through Zoom. The hearing room was filled with legislators, nurses and other interested parties. As Angela spoke, you could hear a pin drop in the room. At the end of her testimony, everyone was speechless. When the Chair finally spoke, she called Angela’s story and testimony stunning.

From that moment on, whenever we went to the Capitol, or engaged in any activities related to our legislation, Angela was with us. Angela was a slight, soft-spoken woman but her grace and gentle character gave her a presence that seemed bigger than life. Her determination to do whatever she could to help assure surgical smoke evacuation became standard practice helped to assure our success. Angela’s testimony at our final Georgia House committee hearing in March 2022 helped secure a unanimous vote, followed by another unanimous vote in the full Georgia House.

During our work together, Angela and I became friends. We only lived three miles apart and stayed connected. She never gave up hope that she would beat the cancer. She called when her cancer returned to say she was entering another clinical trial and to ask me what I thought. As her body weakened, her spirit remained strong. I saw Angela in the hospital just weeks before her death. She was surrounded by her family and close friends. I did not stay long, but told her that we all loved her, and that we were all grateful for all she had done to improve healthcare practice in Georgia.

During the next few weeks, her family and friends would call or text to let me know how she was doing. Angela had asked them to let me know. Angela left us on January 10, 2024, but all she was and all she did remains with us. She accomplished her goal of making the world a better place.

I do remember Angela often, and mourn her absence, as do so many. The thought that accompanies the remembrance is the words of a familiar song — because I knew you, I have been changed for good. Thank you, Angela, for gracing us with your presence.