Despite the countless benefits offered to us by surgical lasers in the way of new treatment solutions, improved efficiency and reduced trauma, it may be possible that they harbor some harmful consequences for patients and practitioners.
Tissue-vaporising lasers emit plume – vapour, smoke, and debris that could contain harmful compounds. “When you look at the content emitted during cautery, laser treatments or procedures using ablative ultrasonic devices, 95 percent is water and 5 percent is particulate,” says Patti Owens, laser practitioner at Online Laser Training USA. “Through in-depth analysis from a variety of studies stemming back to the 1980s, researchers have identified 150 harmful compounds that may be emitted during surgical and aesthetic laser procedures.”
“Other harmful compounds found in plume include: aromatic hydrocarbons, such as benzene, which is a carcinogen; toluene, which can cause liver damage; acrolein, a toxic irritant; hydrogen and cyanide; and inorganic gases such as carbon monoxide,” says Owens. “Researchers have also found nanoparticles smaller than five microns, which can lead to lung damage.”
Reportedly, these harmful or potentially harmful compounds, particularly those emitted by ablative or tissue-vaporising devices include blood and/or viral particles, including HPV and HIV, plus bacteria particles such as staphylococcus and neisseria.
Sadly, the science and evidence-based data has not yet caught up, with The U.S. Occupational Safety and Health Administration noting no reports of disease spread directly as a result of these lasers. Officially, there is little yet known about the short or long term effects of exposure to laser plume, and such, no regulatory requirements in place in the US.
Elissa O’Keefe, Nurse Practitioner and Managing Director of Bravura Education (Australia) says “If you vapourise one gram of tissue with a CO2 laser, you generate airborne contaminants that contain the same amount of mutagenic material as can be found in three cigarettes!”
So how do we avoid exposure, for both practitioners and patients, to this seemingly harmful plume concoction? Elissa has the following advice which she says is also abundantly clear in the new Australian/New Zealand laser standards:
- All laser procedures where plume is generated requires a smoke evacuator whether it be a standalone device or built into the wall
- 0.1µm in-line filters are to be fitted to the suction devices
- Position the smoke evacuator appropriately in the room wherever smoke evacuation will be required
- Check the operation of the smoke evacuator and document on the log sheet
- Check the smoke evacuator filter, and if needed, install a clean filter
- All materials involved in collection of laser generated airborne contaminants are to be disposed of using biohazard disposal procedures.
- Handheld suction devices not designed for the evacuation of plume are not to be used.
- Hold the distal collection tube not further than 2 cm from the point of laser beam incidence within the operative site to maximize the collection of the laser plume
- All personnel close to the operative field need to wear surgical masks (0.2m) and ensure that these fit properly, leaving no gaps around the face.
Please contact [email protected] if you would like to be sent a template for a standard operating policy and procedure for your clinic on laser generated airborne contaminants.