Over the next 10 years, the No. 1 problem surgical facilities will face may very well be OR nurse recruitment and retention. In the fight to attract and keep good help, facilities will have to use all their edges. One edge I think more facilities should use is the creation and enforcement of a surgical smoke filtration policy.

Nobody enjoys breathing in the plume that lasers, electrocautery units and harmonic scalpels produce. But until now, most facilities have done little about it.

One reason is uncertainty. We know surgical smokecan contain chemicals that are noxious to the eyes and airway, that it stinks to the point of triggering nausea, and even that it can contain infectious viral DNA. There are no documented long-term effects, however, and so regulators have been paralyzed. Not long ago, OSHA basically declined to adopt standards related to smoke evacuation, even though pressed heavily to do so.

The other reason is surgeon resistance. For smoke evacuation to be effective, the business end of the tubing has to be extremely close to where the action is. This can make surgery more awkward and obstruct the view of the surgical site. Hoods with their own filtration systems are available, but they can be expensive, impair visualization, and also be bulky and uncomfortable.

Those two hurdles notwithstanding, surgical facility managers who take the bull by the horns now to create and enforce a surgical smoke filtration policy will be glad they did so.

First of all, it's the safe thing to do. Although no one has conclusively proven that surgical smoke can cause infection, no one has proven that it doesn't. Makes a lot more sense to filter the smoke until we know there is no harm rather than the inverse.

Second, it's the smart thing to do. The reason is simple. One of the scarcest commodities in the next two decades will be OR nurses. Although they're loathe to complain, most OR nurses hate surgical smoke, as evidenced by the fact that their organizations have spent lots of time and money lobbying for protection from it . A smoke policy may not be enough alone to attract and keep nurses, but it's almost guaranteed to help.

Finally, it is a reasonable thing to do. Yes, surgeons are going to squawk, and such a policy might even cause one or two to defect. But in general, surgeons are adaptable creatures, as evidenced by how often they change their technique. They are also responsive to scientific evidence, which is reasonably ample with regards to smoke filtration. Also, surgeons benefit just as much as everyone else does.

When office buildings began to ban smoking, a lot of people grumbled and suffered, but they learned to deal with it, and today, being in the office environment is healthier and more pleasant as a result. It's high time to adopt a similar policy in the surgical workplace.

Stan Herrin, Publisher and Editor in Chief