The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: SB 410
INTRODUCER: Senator Garcia
SUBJECT: Protection from Surgical Smoke
DATE: January 12, 2024 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. FP
3. RC
I. Summary:
SB 410 requires hospitals and ambulatory surgical centers (ASC) to, by January 1, 2025, adopt
and implement policies that require the use of a smoke evacuation system during any surgical
procedure that is likely to generate surgical smoke.
The bill provides an effective date of July 1, 2024.
II. Present Situation:
Surgical smoke is produced by the thermal destruction of tissue by the use of lasers or
electrosurgical devices.1 Surgical smoke has been shown to contain toxic gases, vapors and
particulates, dead and live cellular material, and viruses.2
At high concentrations the smoke causes ocular and upper respiratory tract irritation in health
care personnel, and can create view obstruction for the surgeon. The smoke has unpleasant odors
and has been shown to have mutagenic potential.3 Studies have shown that surgical smoke is
causing many complications such as carcinogenicity, toxicity, mutagenicity, irritants, respiratory
diseases, spread of pathogenic microorganisms, Human Papillomavirus DNA transfer, Hepatitis
B transfer, tumor cell transmission, headache, dizziness, drowsiness, bad hair odor and runny
1
The National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Control of
Smoke From Laser/Electric Surgical Procedures, last updated June 30, 2017, available at
https://www.cdc.gov/niosh/docs/hazardcontrol/hc11.html (last visited Jan. 8, 2024).
2
Id.
3
The National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Control of
Smoke From Laser/Electric Surgical Procedures: Engineering Controls Database, last updated Nov. 16, 2018, available at
https://www.cdc.gov/niosh/engcontrols/ecd/detail193.html, (last visited Jan. 8, 2024).
BILL: SB 410 Page 2
eyes.4 Some researchers have suggested that surgical smoke may act as a vector for cancerous
cells that may be inhaled.5
According to the federal Occupational Safety and Health Administration, recognized controls
and work practices for surgical smoke include:
Using portable local smoke evacuators and room suction systems with in-line filters.
Keeping the smoke evacuator or room suction hose nozzle inlet within two inches of the
surgical site to effectively capture airborne contaminants.
Having a smoke evacuator available for every operating room where plume is generated.
Evacuating all smoke, no matter how much is generated.
Keeping the smoke evacuator "ON" (activated) at all times when airborne particles are
produced during all surgical or other procedures.
Considering all tubing, filters, and absorbers as infectious waste and dispose of them
appropriately.
Using new tubing before each procedure and replace the smoke evacuator filter as
recommended by the manufacturer.
Inspecting smoke evacuator systems regularly to ensure proper functioning.6
Additionally, the Joint Commission, a major accrediting organization for hospitals and
ambulatory surgical centers, addressed the issue of surgical smoke in its newsletter entitled
“Quick Safety Issue 56: Alleviating the Dangers of Surgical Smoke.” In the newsletter the Joint
Commission recommends that “health care organizations that conduct surgery and other
procedures using lasers and other devices that produce surgical smoke should take the following
actions to help protect patients and especially staff from the dangers of surgical smoke.
Implement standard procedures for the removal of surgical smoke and plume through the use
of engineering controls, such as smoke evacuators and high filtration masks.
Use specific insufflators for patients undergoing laparoscopic procedures that lessen the
accumulation of methemoglobin buildup in the intra-abdominal cavity. (Surgical smoke is
cytotoxic if absorbed into the blood and can cause elevated methemoglobin.) For example, a
lapro-shield smoke evacuation device — a filter that attaches to a trocar — helps clear the
field inside the abdomen.
During laser procedures, use standard precautions, such as those promulgated by the Blood-
Borne Pathogen Standard (29 CFR 1910.1030) and the Center for Disease Control and
Prevention’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in
All Settings, to prevent exposure to the aerosolized blood, blood by-products and pathogens
contained in surgical smoke plumes.
Establish and periodically review policies and procedures for surgical smoke safety and
control. Make these policies and procedures available to staff in all areas where surgical
smoke is generated.
4
Merajikhah A, Imani B, Khazaei S, Bouraghi H. Impact of Surgical Smoke on the Surgical Team and Operating Room
Nurses and Its Reduction Strategies: A Systematic Review. Iran J Public Health. 2022 Jan;51(1):27-36. doi:
10.18502/ijph.v51i1.8289. PMID: 35223623; PMCID: PMC8837875. Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837875/, (last visited Jan. 8, 2024).
5
United States Department of Labor, Occupational Safety and Health Administration, Surgical Suite >> Smoke Plume,
available at https://www.osha.gov/etools/hospitals/surgical-suite/smoke-plume, (last visited Jan. 8, 2024).
6
Supra n. 5.
BILL: SB 410 Page 3
Provide surgical team members with initial and ongoing education and competency
verification on surgical smoke safety, including the organization’s policies and procedures.
Conduct periodic training exercises to assess surgical smoke precautions and consistent
evacuation for the surgical suite or procedural area.”7
III. Effect of Proposed Changes:
SB 410 creates s. 395.1013, F.S., to require that hospitals and ASCs adopt and implement
policies that require the use of a smoke evacuation system during any surgical procedures that is
likely to generate surgical smoke. The bill defines:
“Smoke evacuation system” to mean equipment that effectively captures, filters, and
eliminates surgical smoke at the site of origin before the smoke makes contact with the eyes
or respiratory tract of occupants in the room; and
“Surgical smoke” to mean the gaseous byproduct produced by energy-generating devices
such as lasers and electrosurgical devices. The term includes, but is not limited to, surgical
plume, smoke plume, bio-aerosols, laser-generated airborne contaminants, and lung-
damaging dust.
The bill requires hospitals and ASCs to adopt and implement the required policies by January 1,
2025.
The bill provides an effective date of July 1, 2024.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
7
Quick Safety Issue 56: Alleviating the Dangers of Surgical Smoke, the Joint Commission, available at
https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-
56/quick-safety-issue-56/ (last visited Jan. 8, 2024).
BILL: SB 410 Page 4
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
SB 410 may have a negative fiscal impact on a hospital and ASC if the hospital or ASC is
required to purchase and maintain equipment in order to meet the requirements of the
bill.
C. Government Sector Impact:
None.
VI. Technical Deficiencies:
None.
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill creates section 395.1013 of the Florida Statutes.
IX. Additional Information:
A. Committee Substitute – Statement of Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
None.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.