ASLMS Laser and Energy Device Plume Position Statement

Approved by the Board of Directors
American Society for Laser Medicine and Surgery, Inc.
April 6, 2017

1. All medical personnel should consider vaporized and ejected tissue plume to be potentially hazardous both in terms of the particulate matter and infectivity.
2. Evacuator suction systems should always be used to collect the plume.
   1. The suction should have a high flow volume with filter changes being made per manufacturer’s recommendations to optimize suction and filter capabilities.
   2. Filers should be chosen which allow for maximum filtering efficiency.
   3. The suction tip must be placed as close to laser impact as possible.
   4. For nanosecond and shorter pulsed lasers, physical barriers that capture the ejected debris or smoke evacuators should be used.
   5. Evacuator suction tips and physical barriers should be handled per manufacturer recommendations after each procedure to eliminate the risk of cross-contamination.
3. Eye protection, masks, gloves, and appropriate clothing should be worn during laser use by all laser personnel when vaporized or ejected tissue plume is generated.
   1. Eye protection should be of a nature which would protect from splatter (as well as wavelength-specific if a laser is used).
   2. Masks should be well-fitting and have highly effective filtration down to the smallest particle size available.
   3. Non-sterile gloves should be worn.

The American Society for Laser Medicine and Surgery believes that plume evacuation or ejected debris barrier apparatus should be provided and utilized in all areas where vaporized or ejected tissue is generated, regardless of its source. We as individuals should be vocal advocates of such good practices. We should support national forums that provide rational education on this topic and other issues concerning the laser and energy-based device environment.

Suggested Resources - Plume and Smoke:

1. Baggish MS, Poiesz BJ, Joret D, Williamson P, et al. Presence of human immunodeficiency virus DNA in laser smoke. LasersSurgMed1991;11: 197–203.
2. Bell ML, Zanobetti A, Dominici F. Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis. Am J Epidemiol 2013;178:865–76.
3. Chuang JS, Farinelli W, Christiani DC, Herrick RF. Gaseous and Particulate Content of Laser Hair Removal Plume. JAMA Dermatol. 2016; E1-9.
4. Formenton G, Bassetto A, De Lorenzo R. Determination of volatile organic compounds in air by GC/MS: Italian proficiency tests. J AOAC Int 2013;96:178–85.
5. Garden JM, O’Banion MK, Bakus AD, Olson C. Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol. 2002;138(10):1303-1307.
6. Garden JM, O'Banion MK, Shelnitz LS, Pinski KS, et. al. Papilloma virus in the vapor of carbon dioxide laser-treated verrucae. JAMA 259(8): 1199-1202, 1988.
7. Gates MA, Feskanich D, Speizer FE, Hankinson SE. Operating room nursing and lung cancer risk in a cohort of female registered nurses. Scand J Work Environ Health. 2007;33(2):140-147.
8. Gatti JE, Bryant CJ, Noone RB, Murphy JB. The mutagenicity of electrocautery smoke. Plast Reconstr Surg. 1992;89(5):781-784.
9. Lewin JM, Brauer JA, Ostad A. Surgical smoke and the dermatologist. J Am Acad Dermatol 2011;65:636–41.
10. Nahen K, Vogel A. Plume dynamics and shielding by the ablation plume during Er:YAG laser ablation. J Biomed Opt. 2002;7(2):165-178.
11. Oganesyan G, Eimpunth S, Soohyun S, Jiang S and B. Surgical Smoke in Dermatologic Surgery. Dermatol Surg 2014;40:1373–137.
12. Ott, D: Smoke production and smoke reduction in endoscopic surgery: preliminary report. Endosc. Surg. Allied Tech. 1(4):230-232, 1993.
13. Sawchuk WS, Weber PJ, Lowy DR, Dzubow LM. Infectious papilloma virus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol 1989;21:41–9.
14. Tomita Y,Mihashi S,Nagata K, et al. Mutagenicity of smoke condensates induced by CO2-laser irradiation and electrocauterization. Mutation Research. 1981; 89:145–149.
15. Ulmer BC. Report of OSHA’s draft: information for health care workers exposed to laser and electrosurgery smoke.TodaysSurgNurse1999;21: 18–9.
16. American Cancer Society. Benzene and cancer risk. http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/benzene.Updated January 5, 2016. Accessed June 5, 2016.
17. American National Standard for Safe Use of Laser in Health Care Facilities (ANSI Z136.3), 2011). Laser Institute of America, 2011.
18. Association of periOperative Registered Nurses (2017 Guidelines for Perioperative Practice.) “Guidelines for Surgical Smoke Safety”.
19. Control of smoke from laser/electric surgical procedures. DHHS (NIOSH) Publications and Products. Vol. 96–128. Center for Disease Control and Prevention, 1996. Available from: http://www.cdc. gov/niosh/docs/hazardcontrol/hc11.html. Accessed November 9, 2013.
20. Laser/electrosurgery plume. Occupational safety and health prevention. United States Department of Labor, 2008. Availablefrom:https://www. osha.gov/SLTC/laserelectrosurgeryplume. Accessed November 9, 2013.