Smoke-Free Surgery: North Carolina Leads the Way

NC law effective 2026 requires surgical smoke evacuation policies, fueling tech adoption and national momentum

2 Jul 2025

Operating rooms across North Carolina are gearing up for a cleaner, safer future. A new state law, signed July 1, 2025, will require hospitals and surgical centers to implement smoke evacuation or filtration systems during procedures that generate surgical smoke. The rule takes effect January 1, 2026, aligning North Carolina with 20 other states that have already made the change.

Surgical smoke, produced by tools like electrocautery devices and lasers, can contain harmful chemicals and fine particles. Nurses and safety advocates have long compared the exposure to secondhand cigarette smoke, warning of respiratory and long-term health risks. With North Carolina's action, those warnings are now being translated into policy.

Hospitals will need to adopt new technology, from smoke-evacuating surgical pencils to portable filtration units. While these upgrades come with costs, they are also expected to spur demand for medical equipment and training programs. The challenge for many facilities will be integrating the new systems without disrupting surgical workflows.

Professional groups have praised the move. "Protecting surgical teams is a basic extension of workplace safety, no different than providing masks or sterile protocols," said a policy director at the Association of periOperative Registered Nurses. The North Carolina Nurses Association, which championed the bill, called the measure a long-awaited victory for operating room staff.

Smaller centers have voiced concerns about expenses and training time, but experts say the investment will pay off through safer environments, improved staff retention, and stronger patient confidence.

North Carolina's law underscores a national shift. With growing awareness and bipartisan support, analysts predict that surgical smoke evacuation could soon become standard practice across the country. For now, the state's message is clear: keeping the air clean in the operating room is no longer optional; it is essential.