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LASER and ESU
American National Standard Institute "The Safe Use of Laser
in Health Care Facilities (ANSI Z136.3 - 1996, 7.3, pg 15)
"Analysis of laser generated airborne contaminants (LGAC)
produced during laser surgical procedures has shown the presence of
gaseous toxic compounds, bio-aerosols, dead concentrations, some of the
LGAC can cause ocular and upper respiratory tract irritation, have
unpleasant odors, create visual problems for the physician and have been
shown to have mutagenic and carcinogenic potential."
"Note: Electrosurgical devices and instrumentation are
often used both separately and simultaneously with lasers. These
devices have been found to produce the same type of airborne contaminants
as produced by laser-tissue interaction and these contaminants should be
evacuated from the surgical site."
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LASER
American National Standard Institute, "The Safe Use of Lasers
in Health Care Facilities" (ANSI Z136.3 - 1998, 7.4, pg 17)
"In most Class 4 laser operations the vaporization of target
tissue produces noxious airborne contaminates that can cause lacrimation,
nausea, abdominal cramping and vomiting. Such airborne
contaminants shall be removed by localized exhaust ventilation. An
alternative is the use of a portable smoke evacuator, using charcoal
and/or HEPA-type filters. Replaceable filters should be monitored
on a regular basis following the manufacturer's recommendations and be
considered as a possible biohazard and disposed of accordingly."
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LASER and ESU
Occupational Safety and Health Administration
(OSHA) General Duty Clause
"Each employer shall furnish to each of his employees employment
and a place of employment which are free from recognized hazards that are
causing or are likely to cause death or serious physical harm to his
employees."
Note: Extensive literature and evidence of the hazards of
surgical smoke would help classify this as a recognized hazard.
NIOSH has determined in their Health Hazard Evaluation Report
88-101-2008 that "exposure to the constituents of the smoke
generated during laser surgery presents a potential health hazard." NIOSH also determined in their Health Hazard
Evaluation Report 88-126-1932 that a potential hazard exists from
exposure to smoke generated by electrocautery knives during reduction
mammoplasty surgical procedures.
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ESU
AORN 1996 Recommended Practices for Electrosurgery (Recommended
Practice IV, pg 159)
"Patients and perioperative personnel should be protected from
inhaling the smoke generated during electrosurgery. An evacuation
system should be used to remove surgical smoke. Research findings
suggest that there is little difference between the smoke generated from
electrosurgery and from lasers. There is an undefined potential
for bacterial and viral contamination of smoke. Toxicity and mutagenicity
of the gaseous by-products exist."
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LASER
AORN 1996 Recommended Practices for Laser Safety (Recommended
Practice IV, pg 212)
"Patients and health care workers should be protected from
inhaling the plume associated with laser use. Plume and noxious
fumes should be evacuated through a filter device. Plume and
noxious fumes are irritating to the respiratory tract. Some
particles in laser plume are classified as hazardous to breathe.
Use of a mechanical smoke evacuator system with a high efficiency filter
during plume generating laser vaporization procedures decreases the risk
of plume inhalation."
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LASER and ESU
AORN Journal editorial March 1996 - "Don't be a
Victim of Surgical Smoke"
"You expose yourself to toxic chemicals (benzene, carbon
monoxide, formaldehyde, hydrogen cyanide, methane, phenol, styrene and
toluene) each time you participate in a surgical procedure in which
smoke from tissue interaction with an electrosurgical device or laser is
not evacuated. The aerosols produced when lasers or
electrosurgical devices are used contain particulate matter, gases,
mutagens, carcinogens and sometimes DNA components. Patients,
surgical personnel and observers are exposed to the same level of toxic
effects. In one study, when smoke evacuators were not used, OR's
filled rapidly (i.e., within five minutes) with particulates and the smoke
plume did not dissipate through the ventilation system until 20
minutes after electrosurgical device ceased. Indifference to
surgical smoke can be hazardous to your health. Don't be a
victim."
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ESU
National Institute for Occupational Safety and Health (NIOSH)
Health Hazard Evaluation Report 88-126-1932
On the basis of the mutagenicity of the airborne compounds collected
during this evaluation and the acute health effects reported by
operating room personnel, NIOSH investigators determined that there is a
potential hazard from exposure to smoke generated by electrocautery
knives during reduction mammoplasty surgical procedures.
Recommendations:
"Engineering ventilation controls (smoke evacuation units) should
be utilized to minimize the acute health effects and further reduce the
potential for any chronic health effects. The smoke evacuation units will also eliminate the emissions that can impair the surgeon's
vision."
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LASER
National Institute of Occupational Safety and Health
(NIOSH) Health Hazard Evaluation Report 88-101-2008
Based on the data obtained during this investigation, it was
determined that exposure to the constituents of the smoke generated
during laser surgery presents a potential health hazard.
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LASER and ESU
National Institute for Occupational Safety and Health (NIOSH)
Hazard Control Bulletin - 96-128, "Control of Smoke from Laser/Electric Surgical Procedures.
Research studies have confirmed that this smoke plume can contain
toxic gases and vapors such as benzene, hydrogen cyanide, 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.
General room ventilation is not by itself sufficient to capture
contaminants generated at the source. The two major 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 reductions 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.
Room suction system 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 smoke generated from non-endoscopic laser/electric surgical
procedures.
The smoke evacuator or room suction hose nozzle inlet must be kept
within 2 inches of the surgical sit 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.
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LASER and ESU
ECRI Healthcare Product Comparison System Study of Surgical
Smoke Evacuator Systems, December 1995
"Smoke evacuation systems are designed to capture the smoke
generated during surgical procedures in which there is thermal
destruction of tissue or bone (e.g., laser surgery, electrocautery,
electrosurgery). While its pathogenicity remains uncertain, the
plume (smoke composed of carbonized cell fragments, water vapor and
hydrocarbons) from vaporized tissue contains small particles (<5um)
and gases that are potentially hazardous. If not evacuated, the
materials can become airborne and deposit in the respiratory tracts of the surgical team, causing lacrimation, nausea, abdominal cramping and
vomiting. The type of surgical instrument, the characteristics of the tissue and the surgeon's technique affect the
quantity and the
characteristics of the smoke plume."
"The smoke generated during laser surgery performed to treat
human papilloma virus (HPV) and other malignancies has the potential to
transmit certain pathogens, there is also the risk of releasing mutagens
and carcinogens into the air, including benzene and formaldehyde in
concentrations that may exceed federal standards."
"While the U.S. Occupational Safely and Health Administration
(OSHA) has no specific standards regarding the use of smoke evacuators,
the American National Standards Institute (ANSI) recommends using
portable smoke evacuators equipped with charcoal and/or high-efficiency
particular air (HEPA) filters during most laser surgeries."
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LASER and ESU
ECRI Health Devices, Vol. 19, No. 1, Page 4, 1/90
"Some hospitals have used vacuum lines to exhaust smoke from the
surgical field. However, the practice is not recommended for two
reasons: particulate matter in the smoke can deteriorate hospital
vacuum systems; the flow generated by the wall suction may not be high
enough to capture the smoke generated at the procedure site."
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ESU
ECRI Health Devices, Vol 19, No. 1, Pager 12, 1/90,
ESU Smoke - Should It Be Evacuated?
"The possible dangers related to inhaling the smoke generated
during electrosurgery have been overlooked in the controversy
surrounding laser smoke. Electrosurgical units (ESU's) are used
for many of the same surgical applications as lasers, including excision
of malignant tumors, in which much smoke is generated. Like CO2
laser surgery, the primary mechanism for cell destruction in
electrosurgery is the heating and ultimate vaporization of water in the
cells."
"Using the protocol described in the performance test, we
determined the particle size distribution generated by a CSV Bovie in Cut
mode set at 100 (not 100W) for 30 seconds and in Coag mode set at 50 to
60 seconds. The results demonstrate that the spectral content of
ESU smoke is very similar to that of laser plume."
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For further information on the hazards of surgical plume, current
studies, updates on OSHA/NIOSH guidelines and/or mandates, please see
our LINKS
page. Here you will find links to important sources of
information and useful articles and publications available on surgical
plume.
