Smoke plume generated during the surgical use of lasers or electro-cautery equipment contains a variety of potentially hazardous substances. The smoke, aerosols, and gases in the plume may contain irritants as well as infectious and carcinogenic substances. As such, it is necessary that staff working in close proximity to the surgical plume take measures to protect themselves from these hazards. This document was developed to establish safety guidelines to help limit medical staff exposures to surgical plumes.
The Joint Commission, American National Standards Institute (ANSI), and the National Institute of Occupational Safety and Health (NIOSH) recognize the need to minimize personnel exposure to surgical plumes. Several means are available to help accomplish this goal, and they are most effective when used in tandem. These measures include the following:
- General room ventilation
- Local exhaust ventilation
- Work practices
- Personnel protective equipment
Each of these aspects is discussed below.
General Room Ventilation
ANSI Standard Z136.3, ‘Safe Use of Lasers in Health Care Facilities’, states that ventilation systems for rooms in which surgical plumes are generated should not re-circulate during such procedures. The ventilation system for some procedure rooms are equipped with means to increase the exhaust rate using a switch or button. The room exhaust should be operated at the highest rate available, and vented outdoors if possible. It is important to realize that even a very efficient general room exhaust will not provide complete protection from plume exposure.
The use of an efficient local exhaust system (scavenger) is essential to minimize staff plume exposure. The following steps should be followed when using such a unit.
- Check filters and hoses prior to use – Change as needed.
- Inspect the system for leaks.
- Keep the evacuator on all at times when plume is being produced.
- Keep the inlet nozzle 1-2 inches from the surgical site to maximize efficiency
- Use the lowest suction rate that will evacuate the plume.
- Dispose of tubing, filters, and adsorbers as infectious waste.
- Assign responsibility for use /maintenance of system.
- Do not use for suction of bodily fluids.
The following work practices should be used to help minimize plume exposure:
- Complete equipment checks for surgical equipment (i.e. laser, electro-cautery unit, etc…) and exhaust systems for proper functioning prior to use.
- Avoid direct contact with the plume whenever possible.
- Use equipment settings to minimize plume production, as applicable.
- Use personnel protective equipment as appropriate.
Personnel Protective Equipment
Most surgical masks are not efficient at removing the components of surgical plume and should not be considered as providing protection to staff. Plumes are composed of very small particulates and smoke requiring HEPA filtration. Utilizing a disposable respirator such as a P-100 would provide a much greater degree of plume protection. Keep in mind that fit-testing through the University Employee Health Clinic is required prior to using a respirator. It is important to note that these masks will not filter 100% of the contents of the plume, only the particulates, and therefore should only be used in conjunction with the other measures described in this document.
In the absence of data to the contrary, smoke and aerosols generated during laser procedures should be considered potentially hazardous. Staff members involved in laser procedures are responsible for implementing the appropriate safety measures in order to minimize staff exposure.
Contact Gordon Axt at 335-8503 with questions. If unavailable, please leave a voice mail message or contact EHS’s main office at 335-8501.