ST. LOUIS — Most St. Louis-area hospitals say they have installed equipment to remove dangerous smoke created during surgeries that contains toxic gases and charred tissue particles, months before a looming statewide deadline to do so.
Missouri in 2023 requiring all hospitals and surgical centers accredited by The Joint Commission, the most common accreditation organization for health care facilities, to have smoke elimination systems. The deadline to comply is Jan. 1, 2026.
“It was exciting that Missouri took note that this is a workplace injury that you don’t even realize you could have later — that down the road, you could get lung cancer,†said Lesley Davidter, director of surgical services for SSM Health St. Clare Hospital in Fenton.
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Surgical smoke, also known as plume, is a gas that is produced when surgical tools such as lasers, electrosurgical units and ultrasonic devices are used to cut or clot human tissue.
The plume can include hazardous chemicals, charred tissue, blood fragments, viruses and bacteria, .
An estimated 90% of all surgical procedures — including cesarean sections, mastectomies, knee replacements and appendectomies — generate surgical smoke.
“Solving the problem is important for patients and staff in the OR,†said Dave Dillon, spokesman for the Missouri Hospital Association, “but explaining why there’s smoke has a pretty high ‘yuck’ factor.â€
Exposure to the often foul-smelling smoke can cause respiratory issues, eye and skin irritations, headaches, nausea, dizziness and drowsiness, studies have shown. The smoke contains chemicals that can cause cancer, and it has the potential to transmit infectious diseases. Surgical masks can’t provide full protection.
Studies have likened the average daily impact of surgical smoke on an operating room team to inhaling the smoke of 27 to 30 unfiltered cigarettes and found that perioperative nurses report twice as many respiratory issues as the general population.
Patients are also at risk, according to research gathered by AORN, despite using closed breathing systems while under general anesthesia.
During surgeries involving small incisions in the abdomen, smoke can be absorbed by red blood cells, depleting the cells’ ability to carry oxygen.
The smoke can also increase the risk of an infection at a port site and interfere with the surgeon’s ability to see, which can prolong the procedure. Exposure to high levels of carbon monoxide is another concern.
“It’s just making the OR safer. That is the goal: to make it 100% safe for the patient and safer for the staff that work in there,†Davidter said.
SSM Health officials say 75% of their outpatient surgery facilities and eight hospitals in the St. Louis region are already smoke-free, with the rest expected to reach full compliance in the coming weeks.
All of the more than 200 operating rooms in BJC HealthCare facilities in the region — including 12 hospitals and seven outpatient facilities — reached compliance with the law this month, said BJC spokeswoman Laura High.
Illinois enacted similar legislation in 2022 requiring the removal of surgical smoke, so the process was already complete at three BJC hospitals in Shiloh, Belleville and Alton, she said.
Mercy, with the most hospitals in Missouri, has long had surgical smoke safeguards in place at its facilities, even before legislation was passed, said Mercy spokeswoman Bethany Pope.
Going smoke-free involves the installation of new equipment, educating staff and completing safety assessments while continuing to provide services to patients, officials say.
St. Clare Hospital took its effort one step further, becoming the first hospital in the region to apply for and receive the Go Clear Gold Award from AORN in June.
AORN, which has long advocated for smoke-free operating rooms, to recognize smoke-free facilities. More than 90% of operating room staff also must score better than 80% on an exam testing their knowledge about the hazards and prevention methods.
Nearly all the staff — 97% — bettered the score, Davidter said. That included Janice Clark, a nurse who has worked in operating rooms for 41 years.
“After all those years of just breathing that in, not even thinking anything about it back in the day ... I was like, ‘Oh, we need to not be smelling or breathing this stuff in,’†Clark said.
Five years ago, only two states required operating rooms to be free of surgical smoke. Now, , the number is 18.
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