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Surgical Smoke Evacuation Laws by State (2026 Update) 

A map of the US with states with requirements for Surgical Smoke is highlighted

Surgical smoke—also called plume—is an unavoidable byproduct of many procedures that use lasers, electrosurgery, or other heat-producing devices. Research has shown that surgical smoke can contain toxic chemicals, viable cellular material, and viral particles, posing real health risks to clinicians, staff, and patients. 

In response, states across the U.S. have enacted laws requiring healthcare facilities to reduce or eliminate exposure to surgical smoke. According to the Association of periOperative Registered Nurses (AORN), 20 states now have enacted legislation addressing surgical smoke evacuation, with several additional laws taking effect in 2026. 

Below is a clear, accurate breakdown of which states require surgical smoke evacuation and how strong those requirements are. 

Understanding the “Levels” of Surgical Smoke Evacuation Laws 

Smoke venturi effect flows up into a surgical smoke evacuator

State laws are not all written the same way. To make this easier to understand, we group them into four practical “levels,” based on how explicit the legal requirement is. 

Level 1 — Smoke Evacuation Required 

These states require hospitals and/or ambulatory surgery centers (ASCs) to use a surgical smoke evacuation or plume scavenging system during procedures that generate smoke. 

Level 2 — Exposure Reduction Required 

These states require facilities to adopt policies to reduce human exposure to surgical smoke. While evacuation systems are the standard solution, the statutory language is less prescriptive. 

Level 3 — Regulation in Development 

These states have passed laws requiring the state occupational safety agency to develop a surgical smoke standard, which will ultimately define evacuation requirements. 

Level 4 — Enacted, Effective in 2026 

These laws are already passed and signed but do not take effect until 2026. 

Level 1 — Smoke Evacuation Required (Currently in Effect) 

Facilities must adopt and implement policies requiring the use of a surgical smoke evacuation system during smoke-generating procedures. 

  • Rhode Island (effective Jan 1, 2019) 
  • Colorado (effective May 1, 2021) 
  • Illinois (effective Jan 1, 2022) 
  • Kentucky (effective Jan 1, 2022) 
  • Oregon (effective Jan 1, 2023) 
  • New York (effective June 14, 2023) 
  • New Jersey (effective June 11, 2023) 
  • Louisiana (effective Aug 1, 2023) 
  • Arizona (effective July 1, 2024) 
  • Washington (effective Jan 1, 2024; small rural facilities Jan 1, 2025) 
  • Connecticut (effective Jan 1, 2024) 
  • Ohio (effective Oct 1, 2024) 
  • Minnesota (effective Jan 1, 2025) 
  • West Virginia (effective Jan 1, 2025) 
  • Virginia (effective July 1, 2025) 

Level 2 — Exposure Reduction Required 

These states require facilities to adopt policies aimed at reducing human exposure to surgical smoke. While not always explicit about evacuation equipment, most facilities comply using smoke evacuation systems. 

  • Georgia (effective July 1, 2022) 

Level 3 — Regulation in Development 

These states have enacted laws directing workplace safety agencies to create enforceable surgical smoke standards. 

  • California 
    Cal/OSHA must propose a surgical smoke standard by Dec 1, 2026, with consideration for adoption in 2027. 

Level 4 — Enacted, Effective in 2026 

These laws are passed and signed but do not take effect until 2026. 

  • Missouri (effective Jan 1, 2026) 
  • North Carolina (effective Jan 1, 2026) 
  • Delaware (effective April 1, 2026) 

What This Means for Dermatology, Laser, and Veterinary Practices 

Most surgical smoke laws are written around hospitals and ambulatory surgery centers, but the clinical risk of surgical smoke does not change by setting. Dermatology clinics, laser practices, veterinary clinics, and outpatient procedure rooms routinely generate plume using electrosurgery and laser devices. 

For many practices, adopting smoke evacuation: 

  • Aligns with AORN guidance and best practices 
  • Reduces staff exposure to toxic byproducts 
  • Supports compliance as regulations continue to expand 
  • Demonstrates a commitment to staff and patient safety 

As more states move toward explicit evacuation requirements, smoke evacuation is rapidly becoming a baseline expectation rather than an optional add-on. 

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Surgical Smoke Regulation Begins to Clear



Surgical Smoke Regulation Begins to Clear
MIAMI – Rhode Island becomes the first state to pass a law requiring the evacuation of surgical smoke in all licensed hospitals and ambulatory surgical centers, whenever a procedure produces plume. Meanwhile expected states like Colorado and California drag their feet and remain unable to get surgical smoke regulations on the books. This precedence setting law will give other states a place to hang their hopes.

Medical device companies like Acuderm haven’t waited on legislation. They anticipated a need and invented a solution. “There is no safe smoke,” said Charles R. Yeh, CEO, of Acuderm, Inc. “Forward thinkers, like those of us at Acuderm, saw the need more than 25 years ago when we developed our first smoke evacuator.

“Currently, there are thousands of facilities across the globe using Acuderm’s patented, state-of-the-art capture, collection and filtration technology to remove harmful particles, viruses carried in blood droplets and toxic gases from the air, while providing safer workplaces in the process,” Yeh continued.


Two years ago, California Bill No. 402 passed the state senate, requiring regulations to be in place no later than June 1, 2019. Despite widespread support, Governor Jerry Brown vetoed this legislation. Meanwhile Rhode Island Governor Gina Raimondo signed a similar law mandating statewide compliance by April 1, 2019.

Since 1996, OSHA (Occupational Safety and Health Administration) has recommended the use of smoke evacuators within two inches of a surgical site to capture airborne contaminates. OSHA’s etool kit for surgical suites states that…

  • Exposure to high concentrations of smoke may cause ocular and upper respiratory tract irritation and create visual problems for the perioperative team
  • Smoke may contain toxic gases that could have the potential for adverse health impacts, such as mutagenic and carcinogenic impacts

Similarly, AORN and NIOSH (National Institute of Occupational Safety and Health) both recommend the same combination of precautions, general room ventilation and local exhaust ventilation (LEV) or a smoke evacuator at the surgical site. Unlike other evacuator manufacturers, Acuderm’s patented TX™ nozzle collects the industry’s largest field of surgical smoke at the ideal distance of 3 to 4 inches.


ABOUT ACUDERM (Acuderm.com)
For more than 35 years, medical professionals have relied upon Acuderm to provide superior value, while maintaining superior quality standards. Patents: FDA (USA), ISO 13485 (International) and CMDCAS (Canada) certified, UL2601 compliant and maintains a CE mark in Europe. For more information and to shop our online store at https://acuderm.com/3-products.