HC11

Control of Smoke From Laser/Electric Surgical Procedures

nazenn

During surgical procedures using a laser or electrosurgical unit, the thermal destruction of tissue
creates a smoke byproduct. Research studies have confirmed that this smoke plume can contain
toxic gases and vapors such as benzene, hydrogen cyanide, and formaldehyde, bioaerosols,
dead and live cellular material (including blood fragments), and viruses. At high concentrations the
smoke causes ocular and upper respiratory tract irritation in health care personnel, and creates
visual problems for the surgeon. The smoke has unpleasant odors and has been shown to have

mutagenic potential.

NIOSH research has shown airborne contaminants generated by these surgical devices can be
effectively controlled. Two methods of control are recommended: Ventilation and Work Practices.

M@ VENTILATION

Recommended ventilation techniques include a combination of general room and local exhaust
ventilation (LEV). General room ventilation is not by itself sufficient to capture contaminants
generated at the source. The two major LEV approaches used to reduce surgical smoke levels
for health care personnel are portable smoke evacuators and room suction systems.

Smoke evacuators contain a suction unit (vacuum pump), filter, hose, and an inlet nozzle. The
smoke evacuator should have high efficiency in airborne particle reduction and should be used
in accordance with the manufacturer’s recommendations to achieve maximum efficiency. A
capture velocity of about 100 to 150 feet per minute at the inlet nozzle is generally
recommended. It is also important to choose a filter that is effective in collecting the
contaminants. A High Efficiency Particulate Air (HEPA) filter or equivalent is recommended for
trapping particulates. Various filtering and cleaning processes also exist which remove or
inactivate airborne gases and vapors. The various filters and absorbers used in smoke
evacuators require monitoring and replacement on a regular basis and are considered a
possible biohazard requiring proper disposal.

Room suction systems can pull at a much lower rate and were designed primarily to capture
liquids rather than particulate or gases. If these systems are used to capture generated
smoke, users must install appropriate filters in the line, insure that the line is cleared, and that
filters are disposed properly. Generally speaking, the use of smoke evacuators are more
effective than room suction systems to control the generated smoke from non-endoscopic
laser/ electric surgical procedures.

orearicg,
" ‘%, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
i Public Health Service
% Centers for Disease Control and Prevention
%, National Institute for Occupational Safety and Health DENTERS FOR OSE ASE GOWTROL

Ma
Saplember 1996


m@ WORK PRACTICES

The smoke evacuator or room suction hose nozzle inlet must be kept within 2 inches of the
surgical site to effectively capture airborne contaminants generated by these surgical devices.
The smoke evacuator should be ON (activated) at all times when airborne particles are
produced during all surgical or other procedures. At the completion of the procedure all
tubing, filters, and absorbers must be considered infectious waste and be disposed
appropriately. New filters and tubing should be installed on the smoke evacuator for each
procedure. While there are many commercially available smoke evacuator systems to select
from, all of these LEV systems must be regularly inspected and maintained to prevent
possible leaks. Users shall also utilize control measures such as "universal precautions," as
required by the OSHA Blood-Borne Pathogen standard.

For More Information

To obtain more information about controlling this hazard, or for information on other occupational
health and safety issues, call the National Institute for Occupational Safety and Health* (NIOSH) at:

1-800-35-NIOSH (1-800-356-4674)

The following reports on this topic are available free upon request from NIOSH:

¢ Evaluation of a Smoke Evacuator Used for Laser Surgery. Lasers Surg. Med. 9:276-261
(1989)

* NIOSH Health Hazard Evaluation and Technical Assistance Reports, HETA 85-126-1932
(1988} and HETA 88-101-2008 (1990).

*NIOSH is the Federal agency responsible for conducting research and making recommendations for preventing
workrelated illness and injuries. HAZARD CONTROLS are based on research studies that show reduced worker
exposure to hazardous agents or activities.

Acknowledgements

The principal contributor to this HAZARD CONTROLS is C. Eugene Moss, Division of
Surveillance, Hazard Evaluations and Field Studies. Assistance was provided by the Education
and Information Division, NIOSH.

This document is in the public domain and may be freely copied or reprinted. NIOSH encourages all
HAZARD CONTROLS be made available to all Interested employers and workers.

DHHS (NIOSH) Publication No. 96-128