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Nursing News HighlightsJ&J + Nurses: Partnering with a Purpose

Improving the Health of Perioperative Nurses by Eliminating Surgical Smoke

According to the Occupational Safety and Health Administration (OSHA)1, more than 500,000 people who work in the operating room – including many who are perioperative nurses – are exposed to surgical smoke each year. Surgical smoke is the by-product of surgical procedures in which an electric device is used to ablate, cut, coagulate, desiccate, fulgurate, or vaporize tissue, and can decrease site visibility and impact air quality in the operating room. In fact, the American Association of periOperative Registered Nurses (AORN) estimates being in an operating room for just one day has the potential to expose operating staff to surgical smoke that is equivalent to smoking 27 to 30 unfiltered cigarettes2.

While surgical smoke poses significant health risks for patients and the entire operating room staff – and, in particular, nurses, who often spend the most time in the operating room preparing the space for surgery and staying with the patient once the surgical team is finished – steps to reduce exposure have not been universally implemented in hospitals and surgical centers across the U.S.

In 2017, the team at Henry Ford Wyandotte Hospital in Wyandotte, Mich., began taking steps toward attaining the AORN Go Clear Award™ through a surgical smoke-free recognition program developed for any facility that wants to improve patient and workplace safety, recruitment, and retention, and be recognized for their commitment to a surgical smoke-free environment. Henry Ford’s Tiffany Tscherne, RN, DNP, CNL, the regional director of surgical services and trauma, worked closely with her colleague Cathy Osgood, RN, MSN, CENP, the chief nursing officer and vice president of patient care services, to lead implementation of the program. Within six months, the Henry Ford team reached more than 93 percent compliance with the program’s standards, including ongoing staff education, an established smoke evacuation protocol, and use of proper operating room equipment. This year, after maintaining an exceptionally high level of compliance with the program’s standards throughout a three-month audit period, Henry Ford Wyandotte Hospital received the AORN Go Clear Gold Award™.

“Implementing the surgical smoke-free recognition program has helped reinforce that we have the responsibility to challenge what we ‘have always done,’” Cathy shared. “Every day, our team is looking for ways for us to improve care, through small tests of change in addition to large initiatives.”

Tiffany and Cathy both credit nurses for driving the smoke evacuation efforts at Henry Ford Wyandotte Hospital, noting the importance of collaboration with all members of the healthcare team and the leadership of elected nursing champions and physician leaders.

“This change was driven by the bedside nurses, and it engaged their nursing skills of advocacy and change management. Smoke evacuation is a well-known skill, but advocacy and change management are skills at the highest level of nursing competency,” Tiffany shared. “Our nursing leadership team worked hard to give our bedside nurses the tools they needed to leverage relationships and evidence-based knowledge at the bedside.”

Ethicon, part of the Johnson & Johnson Medical Devices companies, also understands that nurses hold the key to establishing updated protocols and elevating hospital standards to reduce surgical smoke exposure, and was a proud partner of Henry Ford Wyandotte Hospital as the team implemented the AORN program.

“Nurses can play a critical role in the process as advocates in their organizations to ensure workplace safety issues such as surgical smoke are addressed,” said Andrew Ekdahl, president of Ethicon U.S. “Typically once healthcare providers are informed about the health hazards of surgical smoke exposure, then practices change to include smoke evacuation.”

In addition to providing a suite of products and customer support and education, Ethicon offers the Surgical Smoke Program, designed to help healthcare providers identify and implement practices to reduce surgical smoke exposure. This no-fee program invites an Ethicon clinical specialist – a perioperative nurse or registered nurse with operating room experience, to work with healthcare staff to create a customized program that includes Continuing Education programs on surgical smoke, a smoke evacuation needs assessment, as well as policy creation and implementation support.

“We are committed to reducing exposure to surgical smoke – creating healthier environments for surgeons, nurses, and patients is a priority for us,” said Andrew. “We’re working with healthcare providers across the U.S. to support their plans for effective surgical smoke evacuation through innovative products and training programs.”

Looking ahead, more and more hospitals and surgical centers are working to implement surgical smoke evacuation programs to improve health conditions for patients and healthcare workers alike – and some states may make implementing these programs a requirement. Rhode Island recently became the first state to pass legislation around surgical smoke evacuation.

“One down, 49 more to go. Think of it like sharps safety or wearing gloves – practices that were once hotly contested, but are now part of standard practice. Smoke evacuation is going the same way,” Tiffany shared.

Learn more about surgical smoke evacuation and Henry Ford Wyandotte Hospital on the Friends of Flo podcast, and to find out more about the detailed steps a facility needs to take in order to achieve the AORN Go Clear Award™, visit

1 Laser/Electrosurgery Plume. Occupational Safety & Health Administration. Accessed February 19, 2016.
2 Steege AL, Boiano JM, Sweeney MH. Secondhand smoke in the operating room? Precautionary practices lacking for surgical smoke. Am J Ind Med. 2016; 59 (11) : 1020-1031.

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