Health and Safety Practices Survey of Healthcare Workers

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Surgical Smoke

Here you will learn what we found regarding surgical smoke and best practices for minimizing exposure.


Surgical smoke is produced by the thermal destruction of tissue by use of lasers or electrosurgical devices. Not only is surgical smoke a nuisance because it has a repulsive odor and can obstruct the surgeon’s view of the surgical site, it has been shown to contain1-3:

  • Toxic gases
  • Vapors and particulates
  • Viable and non-viable cellular material
  • Viruses
  • Bacteria

Transmission of human papillomavirus (HPV) through surgical smoke from lasers has been documented.4 Over one-half million healthcare workers including surgeons, nurses, surgical technologists, and others are exposed to surgical smoke each year.2

Acute health effects of exposure to surgical smoke1-3,5 include:

  • Eye, nose and throat irritation
  • Headache
  • Cough
  • Nasal congestion
  • Asthma and asthma-like symptoms

Little is known about the health effects of chronic exposure to surgical smoke.

The surgical smoke survey module consisted of separate submodules for laser surgery and electrosurgery due to differences in safety guidelines and practices associated with each technique. Eligible participants included those who reported that they were within five feet of a source of surgical smoke in the seven days prior to the survey. The survey found that local exhaust ventilation (LEV), a widely recommended engineering control, was not commonly used.

Best practices and study findings

Overall, findings from this survey show that best practices to minimize exposure to surgical smoke have not been universally implemented. Healthcare employers and employees share responsibility to ensure adherence to exposure controls and best practices.

What we found What employers/employees should do
Only half (47%) of respondents reported that LEV was always used during laser surgery and even fewer (14%) reported that LEV was always used during electrosurgery. One of every three respondents said that LEV use was not part of their employer’s protocol. Have employees use LEV for all procedures where surgical smoke is generated. Smoke evacuators should be used in situations where considerable plume is generated and room wall suction systems should be used for controlling small amounts of smoke when there is adequate room air ventilation.3,5-8
49% of laser surgery respondents and 44% of electrosurgery respondents said that they never had training that addressed the hazards of surgical smoke. Train employees on the hazards of surgical smoke and methods to minimize exposure prior to working in areas where surgical smoke is generated.9
Approximately 30% of both laser surgery and electrosurgery respondents said that their employer did not have standard procedures addressing surgical smoke hazards and about 40% did not know if they did or not. Ensure that procedures that address the hazards of surgical smoke are available.8
90% of laser respondents and 98% of electrosurgery respondents used laser masks or surgical masks which do not provide respiratory protection. Use a properly fitted, filtering facepiece respirator (e.g., N95) rather than a surgical or laser mask, especially in situations where LEV is lacking or not functioning properly. Respiratory protection should be at least as protective as a fit-tested N95 filtering facepiece respirator when working with known disease transmissible cases (e.g., HPV) and/or during aerosol-generating procedures or with aerosol transmissible diseases (e.g., TB). 8


1 Ulmer BC. [2008]. The hazards of surgical smokeexternal icon. AORN J 87(4):721–738.

2 OSHA. Laser/electrosurgery plumeexternal icon

3 NIOSH. Control of smoke from laser/electric surgical procedures

4 Hallmo P, Naess O.[1991] Laryngeal papillomatosis with human papillomavirus contracted by laser surgerypdf iconexternal icon. Eur Arch Otorhinolaryngol. 248:425-427.

5 Ball K. 2010. Surgical smoke evacuation guidelines: compliance among perioperative nursesexternal icon. AORN J 92(2):e1–e23.

6 Association of periOperative Registered Nurses (AORN). Recommended practices for electrosurgerypdf iconexternal icon

7 Association of periOperative Registered Nurses (AORN). Recommended practices for laser safety in perioperative practice settingsexternal icon. AORN, Denver, CO, 2012

8 Novak DA, Benson SM. [2010]. Understanding and controlling the hazards of surgical smoke. Prev Infect Ambul Care 1:3–5.

9 OSHA Hazard Communication Standard 1910.1200external icon

Survey and report

To request a copy of this survey, please email

Journal article

(The free full text article will be available in Pub Med Central one year after the article has published)

Page last reviewed: March 30, 2017