Operating Room Personnel’s Perception of Surgical Smoke Inhalation as a Health Hazard: A Systematic Review

Background: Surgical smoke, generated by energy-based instruments such as electrocautery and lasers, poses significant health risks to operating room (OR) personnel. Despite these dangers, awareness and mitigation practices remain inconsistent across healthcare settings. Methods: A literature search of PubMed/MEDLINE, Cochrane Library, JSTOR, Scopus, CINAHL, and Ovid was conducted, adhering to PRISMA guidelines. Inclusion criteria focused on studies utilizing questionnaires to evaluate awareness and protective equipment use among OR personnel. Primary outcomes of interest included OR personnel’s awareness of surgical smoke hazards and the preventative measures in place to limit their exposure. Secondary outcomes included institutional policies and hazard education for the at-risk population. Data extraction and risk of bias assessments were performed independently by two reviewers. Results: From 3,194 articles, 27 full-text articles were reviewed, resulting in the inclusion of 10 studies comprising 4,409 OR personnel responses from seven different countries. More perioperative nurses were surveyed than any other OR personnel. Significant disparities were found in awareness and protective measures. Perioperative nurses demonstrated higher awareness than surgeons and anesthetists, who exhibited lower awareness and inconsistent use of protective measures. Hazard education was the primary predictor for surgical smoke hazard awareness and protective equipment usage. The evident exclusion of trainees, such as medical students and residents, from included surveys underscores a notable gap in research for personnel at risk of future exposure to the occupational hazards of surgical smoke. Discussion: This review demonstrates substantial variability in awareness and protective practices regarding surgical smoke among OR personnel. Perioperative nurses consistently exhibited greater awareness than surgeons and anesthetists, who, despite higher direct exposure, reported lower knowledge and inconsistent use of protective measures. The exclusion of trainees represents a critical deficiency, as early education is vital for fostering safe, long-term practices. Conclusion: These findings underscore the need for standardized training programs and comprehensive institutional policies to improve awareness and ensure consistent adoption of protective measures. Enhanced safety protocols are essential to safeguard OR personnel and ultimately improve patient care outcomes.