Any surgery center can create a smoke-free OR at a relatively low cost when compared with the long-term health and workplace impact of surgical smoke.

“Safety devices are an investment in longevity and staff satisfaction,” says Vangie Dennis, MSN, RN, CNOR, executive director, perioperative services, WellStar Atlanta Medical Center Downtown.

To start a smoke-free OR program, Dennis recommends speaking with the risk manager or person in charge of safety. The program should be evidence-based, and all plans should be analyzed.

“Just get your act together and write down what elements you want to include in a plan,” suggests Kay Ball, RN, PhD, CNOR, professor of nursing at Otterbein University in Westerville, OH.

The impact of OR smoke on patients also should be addressed in any plan, adds Mary Ogg, MSN, RN, CNOR, senior perioperative practice specialist at AORN.

“One of our nurses said she was working at a surgery center, taking a patient back to a room. When she went past an operating room that did not have its smoke evacuated, the patient asked, ‘What is that smell?’” Ogg says.

Dennis, Ball, and Ogg offer several tips for how surgery centers could address OR smoke with the goal of achieving buy-in for eliminating it:

Obtain support from the C-suite. “Go to the monthly board meeting and explain the risks of OR smoke to the board of directors,” Dennis says. Leadership support and commitment should come from the chief of surgery, chief of anesthesia, director of nursing, and the key chiefs of different surgical specialties. AORN offers information about creating a smoke-free OR, which could be helpful when asking for C-suite support.1

Conduct a gap analysis. Some facilities already own some devices they could use to evacuate surgical smoke, or they might have funds available for that type of purchase. Surgery center leaders should conduct a gap analysis to determine what they would need to purchase and how they could disseminate the necessary education about the problem.

“Find out what other hospitals are doing about surgical smoke and ask, ‘What do we need to do?’” Ball offers. “You need organized justification to get new products to fill in a gap that your facility is experiencing. Make a business case for smoke evacuation, build a case for that, develop a plan, and show how we can do it.”

For example, leaders at one surgery center might conclude the facility needs eight smoke evacuators, which cost X each for the capital expenses and X for day-to-day expenses. AORN has developed the Go Clear Program to help facilities figure out how to go smoke free.2

When conducting a gap analysis, there are some questions to ask, including:

-What kind of equipment do we already own?

-Do we own something stored in the back of the supply closet that we could use?

-Do we use fluid management systems that include a smoke evacuation module?

“Different vendors make these systems, and surgery centers that do rotator cuff repairs or ACL repairs might already have those because those procedures go through a lot of fluid,” Ogg notes.

Form an implementation team. A department or surgery center educator or clinical nurse specialist might be the best person to lead a multidisciplinary team, Ogg suggests.

“You should have support from nurses and the surgical technologist and from anesthesia,” she adds. “Anesthesia is exposed to this as much as the nurses in the room. They’re at the head of the table, breathing it in.”

Evaluate products. Surgery centers could use a tabletop model to show staff various options for evacuating smoke.

“Bring in samples from vendors,” Dennis says. “Let people touch, smell, feel the products.”

Show staff the various evacuation products and accessories and describe their attributes. For instance, some evacuators are loud when turned to the highest levels, but a lower level would work just as well for certain surgeries, Dennis explains.

Provide educational modules. OR staff can become complacent about this health risk, which is why they need education about how to evacuate surgical smoke, Ball says. “Put together an evacuation tool kit,” she suggests.

Some surgeons make this a priority because training perioperative nurses requires considerable resources. They do not want a safety issue to jeopardize their ability to retain experienced staff, Ball notes.

“It’s all about workplace safety,” she says. “My research has shown that if you have an easy-to-follow policy, educate people about surgical smoke hazards, and if you have doctors and nurses who talk with each other and work together on policies, then you’re more likely to evacuate plume.”

Staff also will need to be educated about how to use their evacuator products correctly, including proper hook-ups and set-ups, Dennis notes. “Make the education mandatory,” Dennis says. “Bring in experts, and make sure physicians see it.”

A smoke-free OR program will fail if the staff does not understand how to use the equipment properly or if they insist on using it in a way that works, but is uncomfortable for surgeons.

Monitor compliance. “Once you have the education and products in place, go around and make sure people are using it and the smoke is evacuated,” Ogg says. “The goal of the program is a smoke-free environment, and we want to reward people for doing it.”

Apply for an award. Once a facility signs up for the Go Clear Program, there is a dedicated program coordinator who helps facilities with the online process.

AORN offers gold, silver, and bronze awards. At the gold level, an OR is 90%, meaning that 90% of staff have gone through the education, 90% have passed the post-test, and, 90% of the time, the smoke is evacuated at the facility.

Facilities also must install enough evacuators and equipment to cover every OR.

The award is good for three years. After that period ends, facilities can go through compliance monitoring again. There are no site visits; all information provided is based on an honor system. The award is an incentive for nurses to work to make their facilities smoke free, Ball adds.

“We need everyone on board because we want to work in a safe workplace environment,” she says.

“All of the facilities achieving this are so excited and happy. They feel better with the smoke-free environment, and they don’t want to stop,” Ogg says. “Once they know what clear air is like in the operating room, they don’t want to breathe that smoke anymore.”


  1. AORN Facility Reference Center. Tools, Surgical Smoke. Available at: Accessed Sept. 26, 2019.
  2. Association of periOperative Registered Nurses. AORN Go Clear Award Program. Available at: Accessed Sept. 26, 2019.