Digital Debut

New Surgical Smoke Evacuation Requirements to Kick In

Missouri becomes 13th state to enact latest laws

BY STEPHEN ABRESCH | AUGUST 2023

New requirements on surgical smoke evacuation take effect January 1, 2026, in Missouri. Governor Mike Parson (R) signed HB 402 into law in July, enacting the new requirements for healthcare facilities in the state. Under the new law, hospitals and ASCs accredited by The Joint Commission that perform procedures that produce surgical smoke plume from the use of energy-based devices, including but not limited to electrosurgery and lasers, must adopt and implement required policies and procedures to ensure the evacuation of surgical smoke plume by use of a surgical smoke plume evacuation system.

Twelve other states—Arizona, Colorado, Connecticut, Georgia, Illinois, Kentucky, Louisiana, New Jersey, New York, Oregon, Rhode Island and Washington—have enacted their own surgical smoke evacuation requirements, with eight—Colorado, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon and Rhode Island—of those states’ laws already in effect.

The state requirements are, with a few exceptions, largely identical: hospitals and ASCs that perform surgical procedures that produce surgical smoke plumes must adopt policies and procedures to prevent human exposure to surgical smoke through the use of a surgical smoke evacuation system. Georgia and Louisiana’s requirements, however, lack the specificity of other state laws: Georgia’s law only requires hospitals and ASCs to adopt policies for the reduction of human exposure to surgical smoke, without requiring the use of a surgical smoke evacuation system, while Louisiana similarly requires healthcare facilities to adopt and implement policies for a surgical smoke evacuation plan to mitigate and remove surgical smoke plume, without mandating the use of a surgical smoke evacuation system. Missouri’s new law also strays from the requirements imposed by most other states: while the state will require the use of a surgical smoke evacuation system, its requirements direct hospitals and ASCs accredited by The Joint Commission to implement policies and procedures required by The Joint Commission.

While Rhode Island was the first state to enact surgical smoke evacuation requirements, the earliest attempts to enact a state-level requirement began two years earlier in California.

Twenty-three states have introduced 70 bills—Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Iowa, Kentucky, Louisiana, Massachusetts, Missouri, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah, Washington and West Virgina—requiring hospitals and ASCs to implement surgical smoke evacuation policies since 2016. As the Association of periOperative Registered Nurses continues the push to make “smoke evacuation the law across the country and ensure that all operating rooms are surgical smoke-free,” do not be surprised to see surgical smoke legislation show up in a state house near you, if it has not already.

Write Stephen Abresch with any questions.