“A Marathon and a Sprint”: Passing Surgical Smoke Legislation

Surgery with smoke

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Surgical smoke evacuation legislation is an ongoing topic for perioperative nurses, patients, surgeons, and other personnel in the operating room (OR). In a presentation today, March 9, 2024, at the AORN’s International Surgical Conference & Expo 2024, advocates for the passage of legislation for smoke evacuation in New Jersey and Missouri and their struggles to get the legislation passed. The session also gave an update on the legislation in other states in March 2024.

The conference runs from Saturday, March 9, to Tuesday, March 12, 2024. For all ICT’s coverage, go here.

Jennifer Pennock, MS, associate director of government affairs for AORN, spoke first about the legislation overview. The presentation, which had a very full audience, and the positive push that AORN has given to the surgical smoke evacuation legislation status. Pennock noted that there is also a place to sign for more legislation here at the AORN Expo to be taken to the Mass legislation.

“AORN and our members have been advocating for surgical smoke evacuation for many years within facilities and, now, in the last decade, within the halls of state capitols across the country,” Pennock said.

Pennock told the audience that, regardless of the status of surgical smoke legislation in their state, they should always address noncompliance and make sure their policy is clear. She stressed that they should rely on AORN’s resources. AORN has a website about surgical smoke laws.

Next to speak was Felix Rivera, BSN, RN, CNOR, RNFA, a perioperative nurse at Saint Peter’s University Hospital, New Jersey. His story was a positive one: New Jersey was the 11th state to enact the protections into law. New Jersey. It took 2019 to 2023 to enact legislation to protect health care workers and patients from surgical smoke.

He and his dedicated team collected letters from surgeons, surgical techs, nurses, and anesthesiologists, which were submitted for use in legislative action. The team spoke to NJSNA, NJ State Nurses Association, ASTM, NJ State Society of Anesthesiologists, and AORN. He mentioned obstacles the movement faced, including the need to collect more support letters again with each passing year of inaction, periods of inaccuracy, delayed email responses, and the total length of the process, funding, finding volunteers, and arranging time off from work.

Finally, in 2022, they testified at the New Jersey Assembly. Then came the unanimous vote in favor after addressing the meaning of the bill and the significance of its implications.

The law went into effect in New Jersey on June 11, 2023. It is a practice observed as law by New Jersey legislation and is required in all hospitals and surgery centers. Governor Phil Murphy signed it in March 2023.

“This process is time-consuming and can potentially span years of work,” Rivera noted. Time, risk, and commitment are imperative to reaching the finish line and protecting operating room personnel and patients from the dangers of surgical smoke.

Next, Luann Huffman, BSN, RN, CNOR, spoke about Missouri’s journey to surgical smoke legislation from 2019 to 2023. The legislation passed, but it doesn’t take effect until Jan 1, 2026, and it pertains only to The Joint Commission on Accreditation of Healthcare Organizations-accredited facilities. They took props and discussed surgical smoke with the Capitol, and they worked with the Missouri Nurses Association’s (MONA's) executive director.

Additionally, MONA and AORN signed an agreement in 2021 and 2022 to work together to get this approved. Legislative picnics were held across the state to enlist candidate support for MONA’s legislative priorities, with AORN nurses attending most meetings.

In a definite win, a day in February 2023 was declared Surgical Smoke Day in Missouri’s Capitol.

Five nurses set up a surgical demo box to explain what surgical smoke does and how it affects the personnel in the OR. Many legislators took part in the demonstrations. There was opposition, but Senator Beck’s rebuttals worked.

Missouri Hospital Association offered compromised language to Senate sponsor Senator Elaine Gannon, which states that hospitals in the state are accredited by The Joint Commission.

The governor signed the bill into law on July 6, making Missouri the 14th state to go surgical smoke-free. It will go into effect on January 1, 2026. Huffman’s team was not 100% happy with the outcomes, but it was a great first start. The law covers about 85% of all surgical facilities and only ambulatory surgical centers and hospitals).

As the speakers said, there is still much to do in the rest of the country.