In modern surgical suites, patient safety and staff well-being are crucial. Yet, one often-overlooked hazard persists: surgical smoke. Generated by electrocautery, lasers, and other energy-based surgical instruments, this plume contains toxic chemicals, fine particulates, and even viable viruses. Exposure can lead to respiratory issues, eye irritation, nausea, and potential long-term health effects for operating room personnel.
Despite growing awareness, many surgical centers lack proper smoke evacuation systems, leaving staff vulnerable. Regulatory bodies, including OSHA and NIOSH, recommend controlling exposure, and several states have passed laws requiring smoke evacuation systems in hospitals and ambulatory surgery centers.
To mitigate these risks, surgical facilities have several options for controlling and eliminating smoke at its source. Some of these include:
Integrated Smoke Evacuation Handpieces – These devices attach to electrocautery pencils or lasers, capturing smoke at the point of generation before it can disperse into the room.
Standalone Smoke Evacuators – Mobile or wall-mounted filtration units that remove surgical smoke from the OR environment using high-efficiency filters.
Laparoscopic Smoke Filtration – Specialized filtration systems designed for minimally invasive procedures, allowing for safe removal of intra-abdominal surgical smoke.
Surgical Lighting with Airflow Optimization – Some modern surgical lighting systems, such as those with laminar flow openings, are designed to promote air movement above the surgical field. These systems help direct smoke toward evacuation systems, improving visibility and air quality.
Personal Protective Measures – While not a primary solution, the use of N95 or similar respirators can reduce exposure for OR staff when smoke evacuation systems are unavailable.
Each of these solutions plays a role in reducing airborne contaminants, improving surgical visibility, and enhancing the overall safety of the operating room environment.
Beyond localized smoke evacuation, operating room ventilation plays a crucial role in maintaining air quality. OR ventilation systems must be designed to effectively dilute and remove contaminants, including surgical smoke, in compliance with recognized standards such as ASHRAE 170: Ventilation of Health Care Facilities. Key considerations include:
Air Exchange Rates – ORs should maintain a minimum of 20 air changes per hour (ACH), with at least 4 ACH from outside air. Higher ACH rates help dilute airborne particulates, including those found in surgical smoke.
High-Efficiency Filtration – MERV-16 or high-efficiency particulate air (HEPA) filters should be incorporated into the HVAC system to trap fine particulates and chemical contaminants.
Laminar Flow Systems – In some ORs, laminar flow ventilation provides a downward stream of clean air that helps direct contaminants away from the surgical field.
A well-designed ventilation system works in tandem with smoke evacuation devices to create a safer and more controlled surgical environment. Commissioning of HVAC systems, initially and periodically, helps assure they are functioning optimally and contributing to OR safety.
With the rise of state-mandated smoke evacuation policies, surgical facilities must adopt best practices in smoke management. Implementing smoke evacuation solutions, ensuring compliance with ventilation requirements, and training staff on proper use of these systems are critical steps toward a safer OR environment.
As awareness grows, so does the responsibility to act. Investing in smoke evacuation solutions and proper ventilation not only protects surgical teams but also enhances patient care, procedural efficiency, and workplace safety.