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, surgical plumes 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.
- Researchers have suggested that the smoke also may act as a vector for cancerous cells that may be inhaled by the surgical team and other exposed individuals.
- Exposure to high concentrations of smoke may cause ocular and upper respiratory tract irritation and create visual problems for the perioperative team.
- Smoke may contain toxic gases that have the potential for adverse health impacts, such as mutagenic and carcinogenic impacts.
Recognized Controls and Work Practices
- Use portable local smoke evacuators and room suction systems with in-line filters.
- Keep the smoke evacuator or room suction hose nozzle inlet within 2 inches of the surgical site to effectively capture airborne contaminants.
- Have a smoke evacuator available for every operating room where plume is generated.
- Evacuate all smoke, no matter how much is generated.
- Keep the smoke evacuator "ON" (activated) at all times when airborne particles are produced during all surgical or other procedures.
- Consider all tubing, filters, and absorbers as infectious waste and dispose of them appropriately. Use Universal Precautions as required by the OSHA Bloodborne Pathogens Standard when contaminated with blood or OPIM. [29 CFR 1910.1030(d)(1)]
- Use new tubing before each procedure and replace the smoke evacuator filter as recommended by the manufacturer.
- Inspect smoke evacuator systems regularly to ensure proper functioning.
- Laser/Electrosurgery Plume. OSHA Safety and Health Topics Page.
- Control of Smoke from Laser/Electric Surgical Procedures. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 96-128, (1996).
- Association of Perioperative Registered Nurses (AORN)