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Stryker

Stryker is a global leader in medical technologies and, together with its customers, is driven to make healthcare better.

Lobbying Activity

Response to Protection of workers from risks related to exposure to carcinogens at work

20 Oct 2025

We know that cigarette smoke is harmful, and measures exist to reduce its impact on public health. Yet surgical smoke (produced during 85% of surgical procedures(1)) is just as dangerous, and healthcare workers remain largely unprotected. Surgical smoke contains biological compounds that are irritating and carcinogenic. More than 150 toxic substances have been identified, several of which are classified as carcinogens under EU law. A single day in the operating room can expose staff to the equivalent of smoking 2730 cigarettes(2). This makes surgical smoke a significant but underestimated occupational health risk across Europe. However, this topic is growing interest by several organizations throughout Europe, with, for instance, the French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS) which have studied this subject and recognized it as a risk that needs to be addressed(3). Emerging evidence also links exposure to reproductive health problems, including higher rates of infertility and pregnancy complications among female surgeons(4). Surgical smoke can even carry viral DNA such as HPV, with documented cases of transmission to gynecologists. In 2018, among the EUs 1.7 million doctors and 3.1 million nurses, thousands worked daily in operating rooms and were directly exposed. Perioperative nurses, for example, often spend 810 hours per shift in theatres. Despite this, awareness is alarmingly low: up to 82% of operating room staff in France report never receiving any information on the risks(5), with similar findings in Germany and Italy. In total, more than 400,000(6) surgeons and 3 million nurses in the EU are potentially at risk. Current protective measures are inadequate. Standard surgical masks filter out only part of the smoke, allowing 77% of particles to pass through, while general ventilation and laminar airflow fail to capture submicron particles. The most effective solution is source capture: using smoke evacuation systems positioned within 2 cm of the origin and equipped with Ultra-Low Particulate Air (ULPA) filters. Professional organizations such as EORNA and ESNO strongly recommend this approach. Outside of the EU, in the United States, 20 states are now smoke-free in surgical environments thanks to adequate legislation. However, legislative and regulatory action remains fragmented across Europe. Denmark is the only EU country with binding legislation on surgical smoke. Elsewhere, guidelines exist; for example, TRGS in Germany and INRS recommendations in France but implementation is inconsistent, due to limited awareness and lack of mandatory requirements. In France, ANSES has recently established a taskforce to address these issues, but more needs to be done. Surgical smoke is a preventable occupational hazard with well-documented risks, yet it remains insufficiently recognized in EU legislation. The European Commission now has a critical opportunity within the EU Strategic Framework on Health and Safety at Work 20212027 and Europes Beating Cancer Plan to address this neglected risk, establish harmonized protection standards across Member States, and safeguard the health of Europes healthcare workforce. (1) Surgical Smoke Coalition, Surgical Smoke: An Underestimated Hazard, 2022 (2) Hill DS 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, 2012 (3) Eickmann U. et al., Fumées chirurgicales. Risques et mesures de prévention, 2011 (4) Anderson et al., Occupational Reproductive Hazards for Femal Surgeons in the Operating Room: A Review, 2019M. (5) Dupont S, Surgical Smoke, knowledge report (6) Healthcare personnel statistics - physicians - Statistics Explained - Eurostat Full list of references is available on demand.
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