infection control guidelines for dentists

Laser/Electrosurgery Plumes or Surgical Smoke

During surgical procedures that use a laser or electrosurgical unit, the thermal destruction of tissue creates a smoke byproduct. Laser plumes or surgical smoke represent another potential risk for DHCP. Lasers transfer electromagnetic energy into tissues, resulting in the release of a heated plume that includes particles, gases (e.g., hydrogen cyanide, benzene, and formaldehyde), tissue debris, viruses, and offensive odors. One concern is that aerosolized infectious material in the laser plume might reach the nasal mucosa of the laser operator and adjacent DHCP. Although certain viruses (e.g., varicella-zoster virus and herpes simplex virus) appear not to aerosolize efficiently, other viruses and various bacteria (e.g., human papilloma virus, HIV, coagulase-negative Staphylococcus, Corynebacterium species, and Neisseria species) have been detected in laser plumes. However, the presence of an infectious agent in a laser plume might not be sufficient to cause disease from airborne exposure, especially if the agent’s normal mode of transmission is not airborne. No evidence indicates that HIV or HBV have been transmitted through aerosolization and inhalation. Although continuing studies are needed to evaluate the risk for DHCP of laser plumes and electrosurgery smoke, following NIOSH recommendations and practices developed by the Association of periOperative Registered Nurses (AORN) might be practical. These practices include using 1) standard precautions (e.g., high-filtration surgical masks and possibly full face shields); 2) central room suction units with in-line filters to collect particulate matter from minimal plumes; and 3) dedicated mechanical smoke exhaust systems with a high-efficiency filter to remove substantial amounts of laser plume particles. Local smoke evacuation systems have been recommended by consensus organizations, and these systems can improve the quality of the operating field. Employers should be aware of this emerging problem and advise employees of the potential hazards of laser smoke. However, this concern remains unresolved in dental practice and no recommendation is provided here.