Lasers and electrocautery are used for surgery to vaporize, coagulate, and cut tissue. The vapours, smoke, and particulate debris produced during these surgical procedures are called laser plumes.
Laser plume may contain carcinogens, mutagens, irritants, and fine dusts. Plumes may also contain bioaerosols, viruses and cancer cells, blood fragments, and bacteria spores depending on the type of the procedure. They also contain carbon monoxide, polyaromatic hydrocarbons, and various toxic gases. Plumes may contain chemicals such as formaldehyde, hydrogen cyanide, acrolein, and benzene.
Medical staff and patients in hospitals and clinics can be at risk from exposure to laser plumes.
Health symptoms resulting from laser plume exposure include eye, nose, and throat irritation, nausea, vomiting, nasal congestion, chest tightness, abdominal cramping, general flu-like symptoms, and fatigue. These are short-term health effects usually lasting 24 to 48 hours. At present there is no knowledge of potential chronic health effects from long-term exposure to laser plume. However, carcinogens, mutagens and irritants have been found in laser plumes.
The human papilloma virus (HPV) DNA has also been found in the plume of tissue vaporized with carbon dioxide (CO2) lasers. Suspected hazards associated with the laser plumes are the transmission of viable viruses such as human immunodeficiency virus (HIV).
Contaminants generated by lasers and electrosurgical units can be controlled by:
Please see table below for more information.
Contents, Sources, Potential Health and Safety Hazards, & Control Measures
|Laser Plume Content||Source||Potential Health and Safety Hazard||Controls|
|Dust||Procedures using CO2 lasers||- Lung damage||- Appropriate masks.|
- Local exhaust ventilation.
|Toxic chemicals*||Laser beam contact with human or animal tissues, plastics, perfluoro-polyethylene polymer (e.g., Teflon), coated products||- Fire|
- Carcinogenic, mutagenic and teratogenic potential
|- Respiratory protection suitable for plume composition|
- Local exhaust ventilation
|Biological Agents||Laser beam contact with tumours, HIV, culture medium, bacteria, warts, treated skin||- Infection||- Respiratory protection suitable for plume composition|
- Protective clothing and gloves
- Local exhaust ventilation
|Smoke (general)||Laser beam vaporization, incision, CO2 laser beam contact with skin||- Respiratory damage |
- Eye damage
- Obstruction of workers' field of vision
|- Scavenging of smoke near the source|
- Suitable eye and respiratory protection
* Toxic Chemicals can include: benzene, formaldehyde, acrolein, aldehydes, polycyclic aromatic hydrocarbons, cyanides, and methane hydrogen cyanide.
General room ventilation (dilution ventilation) is not sufficient to remove air contaminants. Two types of local exhaust ventilation can be used to efficiently remove the laser plume contaminants.
Smoke evacuators are mobile units consisting of a vacuum pump, filter, hose, and an inlet nozzle placed close to the source of the smoke. The suitable airflow speed of the smoke evacuator for controlling the airborne fumes will depend on the rate of smoke generation.
A mechanical smoke evacuator system with a high-efficiency particulate air (HEPA) or an ultra-low penetration air (ULPA) filter should be used to capture the plume. The air suction ability of filters is significantly reduced when the filter has reached its capacity. Each smoke evacuator should have the capability to detect (e.g., pressure drop) if a filter is getting overload. The nozzle of the evacuator should be placed to capture as much of the plume as possible (within 2 - 5 cm of the lasing site).
In addition to the †smoke evacuation equipment there should also be appropriate equipment for aspirating fluids.
Local exhaust systems remove the laser plume before it reaches people. Hospitals often use the wall suction system for this purpose. In order to be effective the exhaust system must include the following features:
There should be a laser safety program in place and all staff who must work with or near the laser unit should receive:
The CSA Group (CSA) Standard Z386-08 "Safe Use of Lasers in Health Care Facilities" specifies that medical facilities that use Class 3 or 4 lasers shall have a laser safety officer (LSO) and a laser safety committee (LSC) to ensure that laser safety policies and procedures are developed, implemented and maintained. The American National Standards Institute (ANSI) Standards Z136.1 "Safe Use of Lasers" and Z136.3 "Safe Use of Lasers in Health Care" also have requirements for LSOs and LSCs. The OSH Answers document Lasers - Health Care Facilities has additional information on laser safety programs, LSOs and LSCs.
Medical personnel should wear appropriate respirators, eye protection, and gloves during laser surgery and when employing electrosurgical units.
Respirators should be used to provide additional protection and not as a substitute for an air exhaust system. Surgical masks do not eliminate the risk of infection or other hazards from inhaling viruses, germs, chemical vapours, tiny dust particles, aerosols, or cellular debris in laser plumes. If engineering controls do not provide sufficient protection then a properly fitting respirator suitable for the contaminants staff are exposed to should be used as protection against airborne contaminants. OSH Answers has more information about selecting and caring for respirators and about other aspects of setting up a complete personal protective equipment (PPE) program.
Document last updated on June 4, 2009