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Laser Plumes - Health Care Facilities

What is a laser plume?

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.

What is the content of a plume?

Laser plume may contain carcinogens, mutagens, irritants, and fine dusts. Plumes may also contain bioaerosols, viruses, blood fragments, and bacteria depending on the type of the procedure. They also contain carbon monoxide, polyaromatic hydrocarbons, and various toxic gases and vapours. Plumes may contain chemicals such as formaldehyde, hydrogen cyanide, acrolein, and benzene.

Are there any health hazards associated with laser plumes?

Medical staff and patients in hospitals and clinics can be at risk from exposure to laser plumes. Other workplaces may include dental clinics, veterinary clinics, laboratories, cosmetic treatment clinics, and others.

Health symptoms resulting from laser plume exposure include eye, nose, and throat irritation. At present there is no further evidence of other short-term or potential long-term (chronic) health effects from long-term exposure to laser plume. Researchers state that more studies are required. However, carcinogens, mutagens and irritants have been found in laser plumes.

The human papilloma virus (HPV) DNA and the human immunodeficiency virus (HIV) has also been found in the plume.

How can the plume be controlled?

Contaminants generated by lasers and electrosurgical units can be controlled by:

  • Ventilation.
  • Safe work practices.
  • Personal protective equipment.

Please see table below for more information.

Laser Plume
Contents, Sources, Potential Health and Safety Hazards, & Control Measures
Laser Plume ContentSourcePotential Health and Safety HazardControls
DustProcedures using CO2 lasers- Lung damage- Appropriate masks
- Plume scavenging systems (PSS)
Toxic chemicals*Laser beam contact with human or animal tissues, plastics, perfluoro-polyethylene polymer (e.g., Teflon), coated products- Fire
- Irritation
- Carcinogenic, mutagenic and teratogenic potential
- Respiratory protection suitable for plume composition
- Plume scavenging systems (PSS)
Biological AgentsLaser beam contact with tumours, HIV, culture medium, bacteria, warts, treated skin- Infection- Respiratory protection suitable for plume composition
- Protective clothing and gloves
- Plume scavenging systems (PSS)
Smoke (general)Laser beam vaporization, incision, CO2 laser beam contact with skin- Respiratory damage
- Eye damage
- Irritation
- 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.

How can the plume be controlled by ventilation?

General room ventilation (dilution ventilation) is not sufficient to remove air contaminants.

Plume scavenging system (PSS) is the term used for a portable, mobile or fixed device that captures and neutralizes plume. Plume scavenging systems are also known as smoke evacuators, laser plume evacuators, plume scavengers, and local exhaust ventilators.

PSSs generally consist of a filter system with activated carbon for trapping gases, an ultra-low particulate (ULPA) filter for particulates, and an intake that can be placed close to the source of the plume. When the exhaust system used by a PSS is a permanent part of the building, it shall not be combined with other utility systems within the building. The suitable airflow speed of the PSS for controlling the airborne fumes will depend on the rate of plume generation and the exact system used.

The air suction ability of filters is significantly reduced when the filter has reached its capacity. Each PSS should have the capability to detect (e.g., pressure drop or a filter change indicator) if a filter is getting overload, or have a preventative maintenance plan based on filter service life and a change-out plan.

In addition to the PSS, there should also be appropriate equipment for aspirating fluids.

(Adapted from: CSA Standard Z305.13-13 "Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings".)

What safe work practices should be used?

There should be a laser safety program in place and all staff who must work with or near the laser unit should receive:

  • Training on proper procedures for the safe use of equipment.
  • Instructions about how to keep equipment in good working order.
  • Instruction and training to protect patients and clients from exposure.
  • Education about possible health and safety hazards to all workers.

The CSA Standard Z386-14 "Safe Use of Lasers in Health Care" specifies that facilities using lasers shall have a laser safety officer (LSO) and a laser safety committee (LSC) to perform risk assessments, and 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.

The CSA Standard Z305.13-13 "Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings" also requires that:

  • The facility have procedures and policies that are created and kept up-to-date that address the various hazards that may be present.  Procedures should also address purchasing, installation, testing, use, servicing, and maintenance.
  • All disposable PSS equipment including filters, capture devices, and hoses be considered biohazardous and that these items should be handled according to the manufacturer’s instructions or the facility’s policy.

What types of personal protection should workers wear?

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 13, 2014

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Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.