When Janelle Casanave, RN, was pregnant with her first child in 2017 and working in an operating room, she decided there was more to be done to minimize exposure to surgical smoke.

While you may not see it or smell it, surgical smoke occurs when heat-producing devices, such as a laser, are used to stop bleeding or cut or break down a patient’s tissue during surgery.

“It was like being in a room with a group of people smoking cigarettes,” explained Casanave, who works at Kaiser Permanente San Jose Medical Center.

Hazardous smoke, toxic chemicals

The chemicals are different, but cigarettes and surgical smoke are both hazardous. According to studies, the surgical smoke contains harmful, cancer-causing and other toxic chemicals as well as viruses, bacteria, and blood.

In October 2023, California Gov. Gavin Newsom signed a law requiring all operating rooms in California to be smoke-free by 2026. California joins 17 other states with similar legislation, according to the Association for Operating Room Nurses (AORN). The association is leading the effort to make smoke-free operating rooms a legal requirement nationwide.

“We will be in compliance with the California law,” said Janet Jule, DNP, RN, regional executive director of Perioperative Services.

Widespread usage wasn’t always the case 7 years ago when Casanave took on the cause.

“I didn’t want to expose my unborn child to the hazards of surgical smoke,” Casanave said.

With support of her manager, surgeons, and colleagues, Casanave started a Smoke-Free Initiative at the San Jose Medical Center. The goal: Make every operating room smoke-free by consistently using smoke evacuators.

Within 4 months, all 12 operating rooms at the medical center became smoke-free.

The medical center took it a step further.

 In 2019, the San Jose Medical Center was the first Kaiser Permanente facility in Northern California to earn the Gold Status Award from AORN’s Go Clear Program.  This award means that all operating room staff have undergone training of the smoke evacuator, and the medical center showed consistent use of the smoke-clearing equipment. In 2023, the facility was also awarded the OR Excellence Award for Employee Safety. 

‘For everyone’s safety’

San Jose is not the only facility with the Gold Status Award. The Kaiser Permanente Fresno Medical Center has also earned it, with five other medical centers in Santa Clara, Sacramento, Roseville, South Sacramento, and San Leandro currently working toward this certification.  

“I am excited that more medical centers are working for this,” said Nita Rowe, DNP, RN, regional clinical program manager with Perioperative Services. “It’s so important. It’s really for everyone’s safety.”

She said smoke evacuators have come a long way in the past several years. They used to be noisy, rigid, bulky — the size of a microwave — and were difficult to use.

“Now smoke evacuators are smaller, quieter, and more ergonomic — that has helped make them easier to use,” Rowe said. “Everyone wants to use them. The whole team is on board.”