Why it's time for every Aussie operating theatre to go 100% "Smoke-Free"

If you’ve ever worked with lasers in an operating theatre, you’ve probably noticed the haze hanging in the air. That’s surgical plume and it’s far from harmless. In fact, a recent ethical analysis suggests we’re overdue for making surgical plume evacuation systems mandatory in Australian hospitals and clinics.

The science is sobering. Surgical plume contains carcinogens, viruses, viable cancer cells, and chemicals like benzene and hydrogen cyanide. While it's easy to assume theatre ventilation takes care of it, we now know that exposure, especially repeated exposure, poses significant risks to perioperative teams and patients alike (2,3).

A 2022 clinical ethics paper by Daniel Rodger laid out the case for compulsory plume evacuation in no uncertain terms. Using the “principlist” ethical framework (autonomy, beneficence, nonmaleficence, and justice), Rodger argues that it’s unethical and unsafe not to evacuate surgical smoke. And while places like Denmark and several US states have already made plume evacuation systems mandatory, uptake in Australia is patchy at best.

Why this matters in the Australian context

Here in Australia, we already have strong legal frameworks for workplace safety under the Model WHS Act, employers are obligated to minimise health risks “so far as is reasonably practicable.” This includes airborne contaminants. And yet, there’s no national mandate for surgical plume evacuation.

Plus, with COVID-19 normalising PPE and evacuation protocols, there’s never been a better time to make this shift. The technology has improved (less bulky, quieter systems), and the evidence is growing.

Three reasons Aussie theatres must go "Smoke-Free"

1. It’s an avoidable harm and legally risky to ignore.

Workplace exposure to hazardous substances like surgical plume is preventable. Continuing without proper evacuation systems opens facilities up to long-term legal liability under WHS laws.

2. It protects everyone, not just the surgeon.

From nurses to anaesthetists, many people breathe in surgical plume. It’s unjust that some teams benefit from plume evacuation while others don’t, often due to hierarchy or surgeon preference.

3. Long-term savings beat short-term costs.

Yes, equipment has an upfront cost. But fewer sick days, better staff retention, lower infection risks, and future-proofing against litigation make this an economic no-brainer.

At Bravura Education, we believe in championing best practices that protect both patients and professionals. Let’s not wait until harm becomes undeniable. Every operating theatre in Australia deserves clean air – and so do the teams who work in them.

References:

1. Clinical Ethics, Vol. 17(2) 130–135
   
   

2. Hallmo P, Naess O. Laryngeal papillomatosis with human papillomavirus DNA contracted by a laser surgeon. Eur Arch Otorhinolaryngol.;248(7):425-427

3. Rioux, M.,et al (2013). HPV positive tonsillar cancer in two laser surgeons: case reports. Journal of otolaryngology - head & neck surgery . Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 42(1), 54.