Clearing the Air

This post from earlier in the year has been SO POPULAR! As a bonus to you, we are featuring it again over the Christmas and New Year break.

Surgical plume is such an important topic in healthcare settings. Are you clearing the air?

We know that the presence of surgical plume in our operating theatres is a personal risk. More importantly, our patients and colleagues may also be at risk if we are not using appropriate systems to capture and remove the surgical plume from our environment.

We have a duty of care to our patients. So, read Menna’s post and take action to reduce this work health & safety risk.

Sally and I enjoyed catching up with Penny Smalley last week during one of her regular visits to Australia. She was still on a high following an historic win in the baseball World Series for her beloved Chicago Cubs. So plenty of celebrations.

Penny, as many of you will know, is a perioperative nurse, consultant and is recognised as an expert in surgical plume and laser safety. She travels the world running workshops on these topics for medical and nursing staff and providing them with workplace support.

Menna Davies Penny Smalley laser safety smoke plume expert Sally Sutherland-Fraser healthcare consultants perioperative nursing leaders

Menna and Sally with Penny (centre) during one of her regular visits to Sydney to facilitate her laser safety workshops

During this visit she carried out audits in a number of Sydney hospitals on the use of surgical plume evacuators. She was disappointed by the results which showed there was poor compliance with the use of plume evacuators. It does beg the question, why, after all the evidence gathered over the past 20 plus years that plume contains noxious gases, chemicals, viruses and aerosolised particles that have the potential to harm us, do we as perioperative nurses continue to put ourselves at risk on a daily basis?

Did you know, for example, that 1 gram of tissue vaporised using diathermy produces plume is the equivalent of smoking 6 cigarettes in 15 minutes? (Tomita et al, 1989). Note the date of this information – 1989! The dangers of plume are not new, they have been known for decades and yet every day you can walk into an operating suite and smell the diathermy plume. wafting down the corridor. So the message about the dangers is not getting through. Why?

It cannot be through a lack of education, for not only does Penny travel the world providing education on the dangers of plume, there are plenty of nurses and doctors who regularly present papers at perioperative seminars and conferences here in Australia on surgical plume. There are ISO documents and the major perioperative nursing organisations eg ACORN, AORN, Canadian OR Nurses, Association for Perioperative Practice (UK) all of whom have standards on the management of surgical plume.

Is it a lack of leadership? Are OR managers not supporting their staff in providing the appropriate plume evacuation equipment and education? Is it that they prefer to pander to some surgeons who tell them not to waste money as there’s no clear proof demonstrating that plume is harmful?

Is it the staff who don’t speak up and insist on the use of plume evacuation equipment? Admittedly this can be difficult when faced with a surgeon who simply refuses to use the equipment. But this is where leadership comes into play.

This is a serious work health and safety issue, which has eventually been recognised by NSW Health with the publication – GL2015_002 Work Health & Safety – Controlling exposure to surgical plume. It was a long road to finally get the guideline published and Penny was instrumental in this process and with her support of the NSW Operating Theatre Association (NSW OTA) who initiated the lobbying of NSW Health, together with support from Workcover NSW and NSW Nurses & Midwives Association. How many of you know about this guideline? And how many of you use it to support your practice?

What needs to be done to bring us a plume free perioperative environment?

  • More education? Check out the references at the end of the blog for some of the latest and most compelling articles and also websites where you can access further material.
  • Greater assertiveness on the part of the nursing team in the OR in refusing to work if the surgeon does not use evacuation equipment? That would take some guts, but it would send a powerful message.
  • Completing an incident report on the days when the surgeon has refused to use evacuation equipment and your health has been put at risk. That too would send a message to management.
  • Asking the hospital’s Work Health & Safety (WH&S) team to come and undertake a safety audit – that would be pretty powerful too. WH&S should be part of your unit’s staff meeting agenda and another avenue to bring it to the attention of management.

Consider what you can do – but doing nothing is not an option. I end my presentations on management of surgical plume with a quote from former US President, John F Kennedy:

  ‘There are risks and costs to a program of action, but they are far less than the long range risks   and costs of comfortable inaction.’

Feel free to contact us if we can provide you with education resources or you would like us to run workshops for you on the management of surgical plume. We hope next time Penny is in Sydney in 2017, to organise a seminar at which she can update us on the latest in surgical plume evacuation technology and give us a timely reminder of the dangers. Penny has been instrumental in forming the International Council on Surgical Plume (, it’s worth checking out.

bye for now -stay safe…….



Coleman, S. (2014). Protecting yourself against surgical smoke. OR Nurse Journal. March, 41- 46.

Hill, D. et al. (2012). Surgical smoke – a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. Journal of Plastic Reconstructive Aesthetic Surgery 65 (7): 911- 6.

Mowbray, N. et al. (2013). Is surgical smoke harmful to theatre staff? A systematic review. Surgical Endoscopy 27, 3100 – 3107.

Rioux, M. et al. (2013). HPV positive tonsillar cancer in two laser surgeons: case reports. Journal of Otolaryngology – Head & Neck Surgery. 42-54.

Schultz, L. (2014). Analysis of surgical smoke plume components. AORN Journal 99 (2): 289-298.


Nurses Advocating Smoke-Free Theatres Immediately (NASTI)