David
From the laser perspective, the main issue seems to be the potential for viable tissue to survive the procedure and be breathed in by those in the vicinity. There have been (a small number of) reports of genital warts appearing in the airway of clinicians.
BS EN 60825-8, which deals with Guidelines for the safe use of medical laser equipment, states the following:
"2.4 Fumes, plumes and vapours
In most class 4 laser operations, the vaporization of target tissue produces noxious airborne
contaminants. The smoke plume may contain viral particles having a respiratory size of the
order of 0,1 µm.
2.4.1 Goal
Laser generated fumes, plumes and vapours should be removed from the operating environment
to produce a level which is considered acceptable.
2.4.2 Control measures
2.4.2.1 Dedicated smoke evacuation systems
Masks, including special laser surgical masks, are not recommended for use as the primary
method of filtration.
Airborne contaminants should be captured as near as practicable to the source and removed
by local exhaust ventilation. This should be designed to ensure that any potentially infectious
agents are not passed downstream in the air handling/exhaust system. This may be accomplished
with a portable smoke extractor using ULPA filters (at least 0,1 µm) with a filtration
efficiency at this particle size of not less than 99.999 %. Local extraction of fume also
eliminates cellular debris and vapours, thus providing greater visibility for increased precision
and safety.
Replaceable filters should be monitored and replaced on a regular basis in accordance with the
manufacturer's recommendations.
2.4.2.2 High speed particles
Consideration should be given to protecting the eyes and the respiratory tract from particles
which may be ejected at high speed from the treatment site. Laser safety eyewear, if worn,
should provide adequate protection for the eyes."
Our view is that the component in the air should be minimised such that there is no smell, with the fume extracted as close to the site of emission as possible.
John
----
Dr John O'Hagan
Group Leader, Laser and Optical Radiation Dosimetry Group
National Radiological Protection Board
Chilton
Didcot
Oxfordshire OX11 0RQ
UK
Tel: +44 (0)1235 822673
Fax: +44 (0)1235 822650
-----Original Message-----
From: MASLEN-JONES David, Cinical Nurse Mgr
[mailto:[log in to unmask]]
Sent: 03 September 2004 13:29
To: [log in to unmask]
Subject: Re: Surgical smoke
Dear All,
Especially those in the NHS/Healthcare sector,
I have a staff nurse in our theatres with a respiratory problem who has raised the issue of contaminants in surgical smoke produced during diothermy or laser procedures.
This smoke potentially contains all sorts of nasties including virus particles and some sensitisers, we currently have no LEV and a very poor main extraction system in the theatres.
Does anyone have any experience of control systems in theatres, appropriate health surveillance, evidence or research which confirms risk, etc: which I could use to make an argument for the introduction of extraction or which might assist in treatment for my patient
regards
david
David R Maslen-Jones RGN BA Spohn MIOSH
Clinical Nurse Manager, Occupational Health
Plymouth Hospitals NHS Trust
Derriford
Plymouth
PL6 8DH
Tel: 01752 517592 int:57592
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