Plume Discussion

When performing epidermal CO2 laser or electrosurgical procedures, a plume of ‘smoke’ is generated. This smoke is recognized as a source of airborne infection, is a potential respiratory irritant and in general is just undesirable. The smoke, made of various biological constituents, water vapor, etc., exposes the doctor, assistant(s) and patient to a health hazard.

There is a risk that airborne particulate generated by these procedures is carcinogenic, mutagenic or otherwise infectious. The potential presence of viable HIV cannot be discounted. The long-term effects of this type of exposure are not known. What is known is that the risk can be minimized by simply using a properly designed smoke evacuation system to filter this particulate at the surgical site.

While it cannot be stated that a smoke evacuator reduces exposure by 100%, it can be stated that the proper use of a machine specifically designed for the job, which incorporates the proper type of filtration, can reduce exposure to a minimal level. A number of studies have been done worldwide to attempt to quantify the dangers of the smoke plume. Generally, the studies indicate that it is highly recommended that a smoke evacuator be used. These studies also show that it is important to position the suction hose as close to the surgical site as possible — 2 inches maximum; but the closer, the better.

Filtration of the smoke and odors associated with plumes can be easy, effective, beneficial and economical. Filtration enhances the environment in which a procedure takes place. Proper filtration consists of a combination of high efficiency particulate removing filter media and odor reducing media. The filters should be completely external to the evacuator to prevent the contamination of internal machine surfaces, to which you may come into contact when replacing filters. A good system should have a worst case efficiency rating of better than 99.99% at 0.2 – 0.3 microns and should maintain this rating below 0.1 microns.

Typically, filters and hoses are non-sterile; sterility may be required in the OR, for example. The suction hose does not make patient contact, the procedures usually take place in an office environment and are primarily epidermal, airflow is away from the patient and the instant the procedure is started, the hose is contaminated. Due to these facts, sterility is not required in most cases. Sterile disposables are available but the cost is significantly higher.

At the present time, there are no real regulations outlining the use of smoke evacuation equipment. However, you can be 100% certain that regulations will require their use and define where, when and how they’re to be used. Additionally, you can ask yourself: What is most economical in the long run? To save money now by not acquiring a system? Or to invest in a good system and almost totally reduce the risks of long-term health problems, lawsuits, fines by regulatory agencies, etc

Protect yourself, your staff, your patients: your practice.