Fighting to Mandate Smoke Evacuation

By Judy Mathias

Brenda C. Ulmer has been fighting to regulate electrosurgical smoke since 1996. She and others who shared her concerns formed a coalition. They contacted smoke evacuation manufacturers, the National Institute for Occupational Safety and Health (NIOSH), and the Occupational Safety & Health Administration (OSHA). Ulmer also contacted AORN and the AORN Foundation to host round table discussions on surgical smoke. The meeting brought together representatives from the American Society of Anesthesiologists, American College of Surgeons, American Nurses Association, and the Joint Commission.

Ulmer and others worked introduce a bill into Congress. The bill was assigned a number and attached to the omnibus reconciliation bill. The bill made it all the way to budget reconciliation, and then it was eliminated before the bill passed.

Other efforts

In the early 2000s, a relationship developed between AORN, OSHA, and the Joint Commission, and the Joint Commission included smoke evacuation in its accreditation surveys. Also in the early 2000s, Ulmer served on an AORN smoke task force that put together the AORN Position Statement on Surgical Smoke and Bio-Aerosols.

Hope for the future

What the International Council on Surgical Plume is trying to do now is what needs to be done, says Ulmer. The Council is working together to look at new evidence and develop a plan on how to get smoke evacuation uniformly implemented.

One option would be to lobby the Joint Commission to implement stricter standards for smoke evacuation, like they do for fire safety, says Ulmer. “If we could get that focus from them on smoke, that would change the landscape,” she says.

Another option would be to go to Washington, DC, again after the 2016 election because that would allow 4 years to work a bill through the legislative process.

“It‘s a very complex issue and very involved, and I think that is why more hasn’t been done,” says Ulmer. “The number of people it affects is small compared to cigarette smokers; there is still no direct proof that illness is caused by the smoke; and smoke evacuation is going to cost hospitals money,” she says.

Ulmer is on the board of directors of the International Council on Surgical Plume and a member of the Society of American Gastrointestinal and Endoscopic Surgeons Fundamental Use of Surgical Energy (FUSE) committee that developed the FUSE educational program study materials to certify an individual has the fundamental knowledge for the safe use of surgical energy-based devices.

Ulmer says she volunteers to work with these groups because she would like to see regulations in her lifetime mandating surgical smoke evacuation so that the young people who are in the OR now don’t have to worry about the health effects of breathing surgical smoke.

Tips for ensuring mandatory smoke evacuation

“The accomplishments to date are an excellent example of what diverse groups working together can do, says Ulmer, but we must keep fighting.

She gave the following tips for moving mandatory smoke evacuation forward:

  • Make the decision to evacuate smoke
  • Identify champions
  • Use a team approach: Surgeons, perioperative staff, anesthesia personnel, risk managers, occupational health, infection control, and administration
  • Investigate smoke systems
  • Develop smoke policies
  • Educate to evacuate
  • Evaluate compliance

Looking for more information? Find more content on OR safety here.


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