The European Surgical Smoke Coalition publishes the results of its first survey on surgical smoke among healthcare professionals in five European countries

Brussels, November 2022 – The Surgical Smoke Coalition (SSC), a pan-European movement created to raise awareness on the risks associated with surgical smoke, is thrilled to announce the publication of the results of its first survey among healthcare professionals (HCPs) on surgical smoke in five European countries! 

Designed and distributed by EORNA and Stryker, two SSC members, the survey was conducted in 2020-2021 across five European countries, including France, Germany, Italy, Spain and the United Kingdom (UK). Its objectives were to gain a deeper understanding of:  

(1) awareness levels of surgical smoke by HCPs working in hospitals.  

(2) their experiences and knowledge of symptoms associated with it.

(3) the risk management measures put in place in hospitals.  

More than 800 HCPs responded to the survey and shared experiences from their respective countries. 

The results of the survey show a worrying trend across Europe in terms of awareness of surgical smoke and its potential impact. In fact, around 65% of respondents in France and Italy stated that they had not received any information about surgical fumes and its risks.  

Most HCPs who responded to the survey expressed their concerns about the health risks associated with surgical fumes. These concerns were often associated with the observation of concrete negative effects of surgical smoke on their health. For instance, in France, 55% of HCPs reported headaches associated with surgical smoke, while 38% also reported suffering from cough or rhinitis.  

As for the equipment used to protect HCPs, the survey sheds light on a lack of adequate measures with regular surgical face masks most often used as the only protection against surgical smoke in most countries: the UK (85%), France (80%), Spain (78%), and Italy (59%). 

Even if the COVID-19 pandemic has highlighted the importance of protecting the health and safety of HCPs, survey respondents explained that unfortunately no new measures or protocols for surgical smoke were introduced in most countries by hospital management during this period. This is the case for Germany (93%), Italy (69%), Spain (62%), and the UK (52%). As surgical smoke can also transmit infections, such as live bacteria and viruses as, for instance, the human papillomavirus (HPV) during gynaecologic laser procedures, it is concerning that no new measures have been introduced to protect HCPs. 

To conclude, the survey paints a concerning picture for the occupational health of HCPs in operating rooms, across Europe. In light of the survey results, we call on policymakers, regulators, and hospital managers to raise awareness and take on appropriate measures to ensure HCPs are safe against the risks associated with exposure to surgical smoke. 

You may find below the survey pagers summarising the outcome of the survey for France, Germany, Italy, Spain and the UK in English and also individual translations.

Surgical smoke in the operating room. A health risk that does not disappear into thin air

Our President, May Karam, was interviewed by Wirksam, a German medical magazine. In her interview she discussed with Markus Wiegmann, Managing Director of Stryker, the measures and actions to be taken to protect healthcare professionals in the operating room.

The interview provided a great opportunity to mention that there are solutions to make our operating rooms smoke-free, and to protect the health of the healthcare professionals and patients.

You can download and read the full conversation below in English and in German.

The Surgical Smoke Coalition expands with seven new members, including Members of European Parliament Marianne Vind (S&D, Denmark) and Dennis Radtke (EPP, Germany)

Brussels, April 2022 – The Surgical Smoke Coalition, a pan-European movement created to raise awareness of the risks faced by healthcare professionals due to exposure to surgical smoke and share policy and technical solutions, is delighted to be joined by seven additional members.

The Surgical Smoke Coalition was created in May 2021 by three founding organisations to try to minimise the risk of harm from exposure to surgical smoke for healthcare professionals working in operating rooms. Since its creation, the Coalition has already issued an information document on surgical smoke, including a concrete policy call to action to take appropriate measures to protect healthcare professionals from the risks associated with surgical smoke.

André Loose, member of the Coalition and ATA|OTA Chairman1, commented: “Surgical smoke contains a variety of toxic substances, which are recognised as harmful to humans by the EU. According to studies2, the ablation of 1g of tissue produces a smoke plume with an equivalent mutagenicity to six unfiltered cigarettes. A day in the operating room is equivalent to the consumption of more than 27 cigarettes. Doctors, nurses, and technical assistants typically work 8-10 hour shifts in operating rooms, leaving them most exposed to these harms. It is therefore important to raise this issue and call for concrete policy changes.”

In response to these identified risks, it is important to develop appropriate safeguarding measures, ensuring that healthcare professionals and operating rooms have the right evacuation equipment and facilitating better education and training of healthcare professionals.

“Less than one year after its creation, the Surgical Smoke Coalition has doubled in size and grown its membership with high-profile members, who have decided to hold policymakers accountable for putting in place the right policy and technical solutions to prevent surgical smoke hazards for healthcare professionals.”, said May Karam, Chair of the Surgical Smoke Coalition and Member of the European Operating Room Nurses Association (EORNA).

The next planned activity for the Coalition will be to publish a policy report, “Surgical Smoke: An underestimated health hazard”,in the upcoming weeks; the report will include concrete recommendations for European and national policymakers to implement.

MEP Dennis Radtke (EPP, Germany), political Co-Chair of the Coalition, said “I am glad to join the Surgical Smoke Coalition and contribute to strengthening the protection of healthcare professionals working in operating rooms. I will use my mandate at the European Parliament to ensure surgical smoke stays high on the agenda”.


About the Surgical Smoke Coalition – The Surgical Smoke Coalition is a pan-European movement bringing together different members who are concerned by the important issue of surgical smoke and the hazards it poses to those exposed.

The Surgical Smoke Coalition brings together 10 members:

  • MEP Marianne Vind (S&D, Denmark), co-chair of the Coalition
  • MEP Dennis Radtke (EPP, Germany), co-chair of the Coalition
  • EORNA (European Operating Room Nurses Association)
  • ESNO (European Specialist Nurses Organisations)
  • Stryker (One of the world’s leading medical technology companies)
  • EMA (European Medical Association)
  • UEHP (European Union of Private Hospitals)
  • UNAIBODE (National Union of Associations of State Certified Operating Room Nurses)
  • Constance Held (Operating Room nurse)
  • ATA|OTA (German Professional Association of Anaesthetic and Operating Room Technicians)

Surgical smoke, also known as diathermy plume, occurs during surgery and is produced by using surgical devices such as lasers, electrosurgical units, ultrasonic units, cautery units, and high-speed drills and burrs used to cut and dissect tissue.

Surgical smoke can cause direct harms from the particles it contains. It can cause irritation to the eyes, respiratory tract, and skin of hospital operating room staff and has been linked to diseases including occupational asthma and chronic pulmonary conditions.

Some countries have clearer legislation than others to safeguard the health of healthcare professionals. For example,Denmark was one of the first and few countries in the world to implement legislation applicable to surgical smoke, making it mandatory for employers to install extraction systems that remove smoke and other harmful substances as close as possible to the source. Further afield, in the United States, an increasing number of states have passed specific legislation requiring hospitals to use dedicated evacuation systems to tackle surgical smoke.

If you have any questions or wish to know more about the Surgical Smoke Coalition, please contact: secretariat@surgicalsmokecoalition.eu

  1. ATA|OTA is a membership organisation representing the interests of all professionals working in surgical-technical assistance roles nationally (Germany) and internationally. More to be found here: https://ata-ota.org/
  2. Hill, D. S., et al. “Surgical smoke–a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units.”Journal of plastic, reconstructive & aesthetic surgery65.7 (2012): 911-916.