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
This section highlights OSHA standards, standard interpretations (official
letters of interpretation of the standards), and national consensus standards related to
Note: Twenty-five states, Puerto Rico and the Virgin
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
- 1910 Subpart
I, Personal protective equipment [related topic
Respiratory protection. Paragraph
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.
- 1910 Subpart
Z, Toxic and hazardous substances [related topic
- 1910.1030, Bloodborne
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.
Note: These are NOT OSHA regulations. However, they
do provide guidance from their originating organizations related to worker
American National Standards Institute (ANSI)
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
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.
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.
Related Safety and Health Topics Pages