Potential Laser Plume Danger to Doctor, Patient and Personnel with thermal ablative lasers

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Dear colleges:

I believe that it is incumbent on everyone using Thermal Ablative Lasers to understand that the smoke generated from these lasers contain up to 95 % steam and up to 5% solid particulate matter.

Any laser that reaches a temperature above the "Tissue Necrosis" threshold and causes ablation or smoke (Nd:YAG lasers, CO2 Lasers, Erbium Lasers, many Diode Lasers) can be a hazard.

Depending on the type of laser used, energy application, and pulse duration, the vapor from laser treatment can contain particles measuring 100X smaller than generated from drills, at only 0.3 µm (1µm = 1/1000th of a mm) making them even more dangerous.

This makes it a medical necessity (when using a thermal and/or ablative laser) to use not only high vacuum when performing procedures with these lasers, but also high filtration masks for all personnel (and patients) in the room during treatment.

Any micro-organism, can give rise to infectious aerosols, which can lead to emission of viable organisms. With mycotic nails for example, dermatophytic mycosis involves both infectious hyphae and arthrospores that remain infectious for months in the environment with a risk of infection.

The contamination of ambient air in an operating room with pathogens can cause aerogenic infection in exposed persons (generally the patient and medical personnel). If there is extreme and prolonged contamination, other persons may be infected as well, such as the next patient or cleaning personnel.

Microorganisms isolated and identified from nail particles and dust

(1) Staph epidermidis, (2) Staph pyrogens, (3) Staph faecalis, (3) Bacillis, (5) C. albicans, (6) Dermatophytes

Lasers that do not achieve thermal and/or ablative events simply need safety glasses.

References:

Karsai, Syrus, and Georg Däschlein. "“Smoking guns”: Hazards generated by laser and electrocautery smoke." JDDG: Journal der Deutschen Dermatologischen Gesellschaft (2012).

Donaldson, C. L., et al. "Toenail Dust Particles: A Potential Inhalation Hazard to Podiatrists?." Annals of Occupational Hygiene 46.suppl 1 (2002): 365-368.

Gatley M. Human nail dust: hazard to chiropodists or merely nuisance? J Soc Occup Med 1991;41:121–5.

Burrow JG, Millar NA, Stephenson R, et al. Health and safety issues in the use of podiatric nail drills. Journal of British Podiatric Medicine 1996;51:161–4.

Purkiss R. An assessment of the airborne dust in podiatric treatment areas, and its relevance to the use of respiratory equipment. British Journal of Podiatric Medicine 1997;52:129–36.

Larato DC, Ruskin PF, Martin A, et al. Effect of a dental air turbine drill on the bacterial counts in the air. Journal of Prosthetic Dentistry 1996;16:758.

Davies RR, Ganderton MA, Savage MA. Human nail dust and precipitating antibodies to Trichophyton rubrum in chiropodists. Clin Allergy 1983;13:309–15.
Davies RR. Nail dust in chiropodial practice: irritant, allergen and sources of antibodies toTrichophyton rubrum. Journal of the Royal Society of Health 1984;104:2–5.

Millar, N. A. The ocular risks of human nail dust in podiatry. Diss. PhD Thesis, Glasgow Caledonian University, 2000.

Discussion and questions are welcome.

Dr. Eric Bornstein
Chief Science Officer
Nomir Medical Technologies
www.noveoninternational.com
ebornstein@nomirmedical.com
Cell: 508-380-9866

 

New article on Laser Plumes:

An Analysis of Surgical Smoke Plume Components, Capture, and Evacuation

Leonard Schultz, MD, FACS

Abstract
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Abstract

Chronic exposure to surgical smoke can transmit viruses; lead to respiratory illness; and increase the risk of more serious conditions, including Alzheimer disease, collagen and cardiac diseases, and cancer. Despite this, surgical smoke plume capture and evacuation devices are often used sporadically or not at all, and do not necessarily reduce costs per procedure. In addition, the current choices for smoke plume capture are varied, and health care providers may make decisions about what type of method to use based on marketing materials rather than facts, leaving most clinicians and managers frustrated and cynical about supporting the effort to capture surgical smoke plume. This article presents current data and information that purchasing teams can use to help choose the best available technology for their practice patterns. It also provides analysis to help those responsible for choosing smoke evacuation systems make rational decisions in their quest to provide a clean, safe environment in the OR.

http://www.aornjournal.org/article/S0001-2092(13)01212-X/abstract