To evaporate, coagulate, and cut tissue during surgery, ablation (the removal of tissues), or cauterization, lasers, electrocautery devices, and similar tools are employed. These processes produce vapours, smoke, and particulate debris, which are referred to as plumes as a whole.
What does a plume contain?
Depending on the process, plumes may contain bioaerosols, bacteria, viruses, blood clots, cellular waste, and bioaerosols. Additionally, they contain hazardous fumes and vapours, polyaromatic hydrocarbons, and carbon monoxide. Chemicals that arise from gases, dyes, and coolants may also be included in plume. Chemicals like formaldehyde, hydrogen cyanide, acrolein, phenol, butane, and benzene may be present in plumes. Blood-borne infections such as the human papillomavirus (HPV), human immunodeficiency virus (HIV), or bacteria like Bacillus subtilis, Escherichia coli, or Staphylococcus aureus may also be present in a plume along with blood (plasma and blood cells or bits of cells).
Are there any risks to one's health from plume?
Eye, nose, throat, and respiratory irritation are among the health issues that can arise from exposure to plumes. Headaches, nausea, and muscle weakness may also be health issues. Some substances could be carcinogenic or mutagenic in the long run. The risk of infections exists, just like it would with other biomedical waste. Eye and respiratory irritation while operating raises safety concerns and may impair the operator's ability to accomplish the task at hand.
Who is susceptible to plume exposure?
Patients, medical workers, and patients in clinics and hospitals may be at risk from exposure to plumes. Cleaning employees and those responsible for equipment maintenance or repair are other parties that could be exposed. Risk of exposure may arise when lasers are utilized in dentistry clinics, veterinary clinics, laboratories, cosmetic treatment clinics, and other settings. The method and tools employed, as well as the presence and quantity of any chemicals, dyes, or coolants, will determine the level of danger (and any by-products) the patient's health and the degree of exposure (e.g., concentration in the air) the efficiency of the measures taken
How is the plume to be managed?
To ascertain how workers are exposed to plume and what control measures are required, workplaces should conduct a hazard identification and risk assessment. Laser and electrosurgical unit-generated contaminants can be managed by: Elimination (e.g., investigate if there are other ways to do the technique that does not cause plume) (e.g., determine if there are other ways to perform the procedure that does not produce plume) Ventilation and plume scavenging systems are examples of engineering controls (local exhaust) Administrative measures including training, education, and safe work practices Personal protective equipment, such as gowns, respirators, gloves, and eye and face shields. Along with usual practices and other infection control measures, these controls would be used. Protection from the laser and the equipment itself can necessitate the use of additional controls. For more details, please refer to the OSH Answers on Lasers - Health Care. For more details, please refer to the table below. Table 1: Content of the Plume Contents, sources, potential health risks, and control measures for plumes Potential Health and Safety HazardControlsPlume ContentSource Procedures for dust using CO2 lasers - Lung injury - The proper respirators - Systems for scavenging plumes (PSS) Chemicals that are toxic*Laser beam interaction with tissues from people or animals, plastics, perfluoro-polyethylene polymer (such as Teflon), and coated goods - Fire Respiratory protection appropriate for plume composition, irritation, and risk for carcinogenicity, mutagenicity, and teratogenicity - Systems for scavenging plumes (PSS) Bioactive Agents Infection from laser beam contact with warts, cultured bacteria, HIV, or treated skin. Respiratory protection appropriate for plume composition. - Gloves and protective attire - Plume scavenging systems (PSS) Smoke (general) (general) Laser vaporization, incision, and skin-contact with a CO2 laser cause respiratory harm. - Eye injury - Irritation - Blocking the view of workers - Scavenging smoke close to the source - Appropriate eye and respiratory protection * Benzene, formaldehyde, acrolein, aldehydes, polycyclic aromatic hydrocarbons, cyanides, and methane hydrogen cyanide are examples of toxic chemicals.
How can ventilation manage the plume?
Air pollutants cannot be removed by dilution ventilation (general room ventilation). The phrase ""plume scavenging system"" (PSS) refers to a piece of equipment that neutralizes and catches plumes. The terms smoke evacuators, laser plume evacuators, plume scavengers, and local exhaust ventilators are also used to describe plume scavenging devices. The CSA Standard Z305.13-13 (R2020), ""Plume Scavenging in Surgical, Diagnostic, Therapeutic, and Aesthetic Settings,"" provides instructions on how to use a PSS. PSSs typically include an intake that can be positioned close to the source of the plume, a filter system with activated carbon for capturing gases, and an ultra-low particulate (ULPA) filter for capturing particulates. When a PSS's exhaust system is a permanent fixture of the building, it is forbidden to integrate it with any other utility systems there. The rate of plume formation and the specific system being employed will determine the PSS's appropriate airflow speed for reducing airborne fumes. When a filter reaches its capacity, its ability to suction air is greatly diminished. Each PSS should have the capability to detect (e.g., pressure drop or a filter change indicator) if a filter is getting overload, or have a preventative maintenance plan based on filter service life and a change-out plan. When a PSS is used, the workers involved should have received the necessary training on how to use, maintain, and service the PSS (e.g., positioning of the intake, verification of flow settings, filter replacements, etc.), In addition to the PSS, other equipment may be required during the procedures, such as appropriate equipment for aspirating fluids. (Adapted from: CSA Standard Z305.13-13 (R2020) """"Plume scavenging in surgical, diagnostic, therapeutic, and aesthetic settings"""".)
What kinds of personal protection must employees to put on?
Medical personnel should wear appropriate respirators, eye protection, and gloves during laser surgery and when employing electrosurgical units.
Respirators should be used to provide additional protection and not as a substitute for an air exhaust system. Surgical masks do not eliminate the risk of infection or other hazards from inhaling viruses, germs, chemical vapours, tiny dust particles, aerosols, or cellular debris in laser plumes. If engineering controls do not provide sufficient protection then a properly fitting respirator suitable for the contaminants staff are exposed to should be used as protection against airborne contaminants. OSH Answers has more information about selecting and caring for respirators for health care workers, and about other aspects of setting up a complete personal protective equipment (PPE) program.""" - https://www.affordablecebu.com/
