Guest Column

Physicians go into health care with the goal to help people. Ambulatory surgery centers, or ASCs, are licensed health facilities that are either partially or wholly owned by these physicians, and their goal never changes to provide the best care possible for their patients. In order to accomplish this goal, physicians employ a team of clinical experts and develop comprehensive policies and procedures to safeguard not only the patient but also the staff working in the ASC.

The March 17 op-ed article written by Brenda Larkin, overstated the problem with surgical smoke. The Association of Perioperative Registered Nurses, AORN, is developing unnecessary legislation to create yet another layer of regulatory burden on health care facilities. A majority of ASCs have already voluntarily adopted policies for the evacuation of surgical smoke during appropriate procedures. They have partnered with AORN to provide education to clinical experts around the state about the potential hazards and how facilities can best mitigate these risks. The state trade association and the Oregon Ambulatory Surgery Center Association ( promote the AORN-developed surgical smoke policy for those that do not already have one in effect.

Local Bend ASC administrators have discussed this issue and have collectively agreed that all safety precautions are taken when the use of cautery is present and creates a smoke plume. A smoke evacuator is used and/or N95’s worn when it is anticipated that a smoke plume would be generated by a Bovie or laser. It is important to note that ASCs do not perform nearly the number or types of procedures that generate a lot of smoke as the hospital does. ASCs use proper personal protective equipment and have air exchange rates that exceed requirements set by the state to protect public health and safety.

Additionally, ASCs promote a culture of community, transparency and communication with all staff at the facility. ASC administrators highly encourage operating room staff to bring safety concerns forward, and our surgeons take raised safety concerns seriously. ASCs are small businesses, and we enjoy a positive work environment and closer working relationships than some larger operating room environments.

Surgical smoke evacuation systems should not be used in every case. Not every case produces surgical smoke. Surgeons and nurses are capable of determining which cases generate smoke, and when the need for increased safety precautions are indicated. If any unsafe practice exists within any facility’s operating room, the leadership in that facility should address it, and have existing policies and practices, including staff education. The facility should foster an environment where staff feel comfortable bringing safety concerns forward, and a means for them to do so.

The Oregon Ambulatory Surgery Center Association has a tag line of “our patients come first,” and it appropriately underscores our commitment to a safe operating room environment. ASCs here are committed to be an integral part of the Bend community, in providing safe and cost effective surgical procedures for patients as well as quality employment for the staff of our facilities.

The authors are Cammy Gilstrap, RN, the CSC Director at Cascade Surgicenter; Neal Maerki, RN, CASC, is the administrator at Bend Surgery Center; Neil Allen is administrator at Deschutes Surgery Center; Chris D. Skagen, JD, MELP, is executive director of the Oregon Ambulatory Surgery Center Association.

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