OSHA Hazard Information Bulletins
Hazard of Laser Surgery Smoke.
 OSHA Safety and Health Information Bulletins - Table of Contents
- Information Date: 19880411
- Record Type: Hazard Information Bulletin
- Subject: Hazard of Laser Surgery Smoke.
April 11, 1988
| MEMORANDUM FOR: |
REGIONAL ADMINISTRATORS |
| THROUGH: |
LEO CAREY
Director
Office of Field Programs |
| FROM: |
EDWARD BAIER
Director
Directorate of Technical Support |
| SUBJECT: |
Health Hazard Information Bulletin: Hazard of Laser
Surgery Smoke |
The use of laser to perform surgery has gained wide acceptance in recent
years. Carbon dioxide laser is the most frequently used laser in surgery due
to its precise cutting ability, coagulating effect on small blood vessels,
and low trauma to surrounding tissue areas. The energy supplied at the focal
point of the carbon dioxide laser is so great that the tissue and fluid are
vaporized. Researchers have suggested that the smoke may act as a vector for
cancerous cells which may be inhaled by the surgical team and other exposed
individuals.
There have been many studies on this subject. One study in 1987 by Camran
Nezhat et. al. (1) examined the compositions of the smoke plume produced
during carbon dioxide laser surgery to determine whether the operating room
team was at risk from the laser smoke. The authors were interested in
calculating the probability that something the size of a whole red blood cell
(7.5 um) would be present in the smoke. Particles with an aerodynamic
diameter range from 0.1-0.8 um were found in the collected smoke plume
samples but no cell-size particles, including cancer cells, were present in
the plume (probability 0.000001).
The findings of this study differ from some earlier studies in which intact
cells or identifiable cell parts were collected from both carbon dioxide and
neodymium: yttrium-aluminum-garnet (YAG) laser radiation of animal tissue.
The conclusion of the Nezhat study was that although no identifiable hazard
from airborne cancer cells was detected, a significant portion of the
particles in the smoke was in the range of 0.5-5.0 um. These particles are
too small to be effectively filtered by surgical masks. It was recommended
that a mechanical smoke evacuator system with a high-efficiency multi-stage
filter be used during smoke generating laser vaporization procedures.
An article by Robert Fisher (2) indicated that although mechanical smoke
vacuuming systems were used in carbon dioxide laser surgery, the tube had to
be held as close as 1 cm from the target. At 2 cm, the evacuation ratio was
down to 50%. The author concluded that prudence should be exercised while
the hazards presented by the laser smoke are further investigated.
The most recent study published in February, 1988 by Garden et. al. (3)
analyzed the vapor produced by the carbon dioxide laser during vaporization
of papillomavirus infected verrucae. This study concluded that intact viral
deoxyribonueleic acid (DNA) was liberated into the air with the plume of
laser-treated verrucae. Papillomavirus DNA has been demonstrated to be
infectious. Therefore, when performing laser therapy on patients infected
with viruses such as hepatitis or the human immunodeficiency virus, the smoke
plume should be assumed to be infectious and appropriate precautions, such as
a well maintained vacuum apparatus should be observed.
"American National Standard for the Safe Use of Laser in Health Care
Facilities," ANSI Z-136.3 will be published in June, 1988. The standard
provides guidance for safe use of lasers and laser systems for diagnostic and
therapeutic uses in health care facilities. The standard takes into
consideration the unique problems related to operating rooms, outpatient
clinics, and private medical offices. The hazard classification scheme
detailed in ANSI Z-136.3 is identical with that in ANSI Z-136.1, "American
National Standard for the Safe Use of Lasers" already published and available
for use.
Compliance and consultative personnel should be aware of this emerging
problem and advise medical personnel of the possible hazard of laser smoke
during compliance inspections and consultative visits. Please disseminate
this information to Area Offices, State Plan States and Consultation Project
Officers.
References:
(1) Nezhat C, Winer W, Nezhat F et. al.: Smoke from Laser
Surgery: Is there a hazard? "Lasers in Surgery and Medicine" 7: 376-382,
1987.
(2) Fisher RW: Laser smoke in the operating room, "Biomedical
Technology Today" 191-194, 1987.
(3) Garden JM, O'Banion KM, Shelnitz LS et. al.: Papillomavirus
in the vapor of carbon dioxide laser - treated verrucae, "Journal of American
Medical Association," 259: 1199-1202, 1988.
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