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Laser/Electrosurgery Plume

During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Each year, an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke. Surgical plumes have contents similar to other smoke plumes, including carbon monoxide, polyaromatic hydrocarbons, and a variety of trace toxic gases. As such, they can produce upper respiratory irritation, and have in-vitro mutagenic potential. Although there has been no documented transmission of infectious disease through surgical smoke, the potential for generating infectious viral fragments, particularly following treatment of venereal warts, may exist. Local smoke evacuation systems have been recommended by consensus organizations, and may improve the quality of the operating field. Employers should be aware of this emerging problem and advise employees of the hazards of laser smoke.

There are currently no specific OSHA standards for laser/electrosurgery plume hazards.

Standards

This section highlights OSHA standards, standard interpretations (official letters of interpretation of the standards), and national consensus standards related to laser/electrosurgery plume hazards.

OSHA

Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.

General Industry (29 CFR 1910)

  • 1910 Subpart I, Personal protective equipment [related topic page]
    • 1910.134, Respiratory protection. Paragraph (a)(1) states the primary objective is to control occupational diseases caused by breathing air contaminated with harmful substances. This is to be accomplished through accepted engineering controls if feasible, or through the use of appropriate respirators. Note: Surgical masks used to prevent contamination of the patient are not certified for respiratory protection of medical employees. [related topic page]
  • 1910 Subpart Z, Toxic and hazardous substances [related topic page]
    • 1910.1030, Bloodborne pathogens. Paragraph (d)(3)(i) states the employer must supply appropriate personal protective equipment such as gloves, gowns, masks and eye protection. This standard would apply if such items become contaminated with viable bloodborne pathogens from laser smoke or plume. [related topic page]

Standard Interpretations

National Consensus

Note: These are NOT OSHA regulations. However, they do provide guidance from their originating organizations related to worker protection.

American National Standards Institute (ANSI)

The American National Standards Institute (ANSI) has developed several standards relating to laser hazards and non-beam hazards. They are recognized as a minimum standard for laser safety.

  • Z136.1-2007, Safe Use of Lasers, (2007).

  • Z136.3-2005, Safe Use of Lasers in Health Care Facilities, (2005).

Health Effects and Possible Solutions

  • Hazard of Laser Surgery Smoke. OSHA Hazard Information Bulletin (HIB), (1988, April 11). Associates potential airborne biological hazards with the use of lasers during surgery.

  • Control of Smoke from Laser/Electric Surgical Procedures. US Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 96-128 (Hazard Controls 11), (1996). Describes the hazards and methods to control smoke plumes when using lasers or electrosurgical units during surgery.

  • Laser Plume in Surgical Procedures. Canadian Centre for Occupational Health and Safety (CCOHS), Ontario Ministry of Labour Information Alert 24, (1992, August 19). Describes hazards and control recommendations for laser plume.

Additional Information

Related Safety and Health Topics Pages