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United States


Occupational Safety & Health Administration (OSHA)

OSHA is the only U.S. regulatory body to date that has legal authority in the United States granted by Congress. They estimate that 500,000 healthcare workers are exposed to surgical smoke and bio-aerosols each year. On a number of occasions OSHA has reiterated that the management of surgical plume is a healthcare worker safety issue. They have also indicated that plume hazards fall under the scope of the following:

  • General Duty Clause
    • "Each employer shall furnish to each of his (sic) employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."
  • Personal Protective Equipment (PPE)
    • Controlling a hazard at its source is the best way to protect employees.

Recommended Practices & Standards:

National Institute of Occupational Safety and Health (NIOSH)

NIOSH is part of the Centers for Disease Control and Prevention (CDC) within the Department of Health and Human Services. NIOSH provides recommendations and interventions for the building of a healthy, safe and capable workforce.

  • HC 11 - Control of Smoke from Laser/Electric Surgical Procedures
    • Recommended ventilation techniques include a combination of general room and local exhaust ventilation (LEV). General room ventilation is not by itself sufficient to capture contaminants generated at the source.

The Joint Commission

The Joint Commission is an independent, not-for-profit organization. The Joint Commission accredits and certifies more than 20,500 health care organizations and programs in the United States and writes standards by which they measure healthcare facilities compliance.

  • Environment of Care EC02.02.01
    • Healthcare facilities manage their risks related to hazardous materials and waste
    • The hospital minimizes risks associated with selecting, handling, storing, transporting, using, and disposing hazardous gases and vapors
    • Hazardous gases and vapors include, but are not limited to, glutaraldehyde, ethylene oxide, vapors generated while using cauterizing equipment and lasers, and gases such as nitrous oxide

Association of periOperative Registered Nurses (AORN)

AORN is a professional association based in Denver, Colorado that represents the interests of more than 160,000 perioperative nurses. The following are contained in Recommended Practices:

2017 AORN Guideline for Surgical Smoke Safety 

Recommendation I

“The health care organization should provide a surgical smoke free environment.”

Recommendation II

The perioperative team should evacuate all surgical smoke.

“The collective evidence, standards, and guidelines from NIOSH, the Healthcare Infection Control Practices Advisory Committee, and professional organizations indicates that evacuating surgical smoke protects patients and health care workers from the hazards of surgical smoke.”

Recommendation III

“Perioperative team members should receive initial and ongoing education and competency verification on surgical smoke safety.”

Recommendation IV

“Policies and procedures for surgical smoke safety should be developed, reviewed periodically, revised as necessary, and readily available in the practice setting in which they are used.”

Recommendation V

“Perioperative personnel should participate in a variety of quality assurance and performance activities that are consistent with the health care organization’s plan to improve understanding and compliance with the principles and processes of surgical smoke safety."

2017 Guidelines for Perioperative Practice, First Published: December 2016.
Copyright © 2017 AORN, Inc. All rights reserved.

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