Laser Plume From Human Papillomavirus–Infected Tissue: A Systematic Review

Cox, Surget V.; Dobry, Allison S.; Zachary, Christopher B.; Cohen, Joel L.

doi:10.1097/dss.0000000000002757

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…Several other scenarios and clinical experiments continue to replicate similar results and demonstrate the increasing incidence across multiple medical specialties. 9 Thus, this further supports the importance of quantifying and preventing infectious HPV laser plume exposure in the field of dermatology.…”

supporting

confidence: 63%

The dangers of human papillomavirus (HPV) laser plume and best safety practices

Stetkevich

Burkhart

2021

Int J Dermatology

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Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.

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supporting

confidence: 63%

The dangers of human papillomavirus (HPV) laser plume and best safety practices

Stetkevich

Burkhart

2021

Int J Dermatology

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“…32 In addition, laser surgeons use a smoke evacuator to capture laserinduced fume, containing hazardous substances including toxic, carcinogenic, and viral pathogens, such as HPV when treating warts. 33 Limitations of this study include the use of SAL to mimic BLM aerosol formation in the room ventilation experiments. Formed SAL aerosols may be an underestimation of the produced BLM aerosols, which emphasizes the use of a high-powered evacuator system to capture airborne aerosols as a safety measure in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, Mohs surgeons are advised to use personal protective measures and a smoke evacuator when treating the oral or nasal mucosa 32 . In addition, laser surgeons use a smoke evacuator to capture laser‐induced fume, containing hazardous substances including toxic, carcinogenic, and viral pathogens, such as HPV when treating warts 33 …”

Section: Discussionmentioning

confidence: 99%

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Needle‐free jet injection‐induced small‐droplet aerosol formation during intralesional bleomycin therapy

et al. 2021

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Objectives: Needle-free jet injectors are frequently used in dermatological practice. Injection-generated small-droplet aerosols could be harmful upon inhalation when chemotherapeutics, like bleomycin, are used. Here, we aim to explore jet injector-induced small-droplet aerosol formation of bleomycin in relation to air ventilation and to provide safety measures for clinical practice. Materials and Methods: With a professional particle sensor, we measured airborne aerosol particles (0.2-10.0 µm) after electronic pneumatic injection (EPI), springloaded jet injection (SLI), and needle injection (NI) of bleomycin and saline (100 μl) on ex vivo human skin. Three levels of air ventilation were explored: no ventilation, room ventilation, and room ventilation with an additional smoke evacuator. Results: EPI and SLI induced significant small-droplet aerosol formation compared with none after NI (0.2-1.0 µm; no ventilation). The largest bleomycin aerosol generation was observed for the smallest particles (0.2-1.0 µm) with 673.170 (528.802-789.453) aerosol particles/liter air (EPI; no ventilation). Room ventilation and smoke evacuation led to a reduction of ≥99% and 100% of measured aerosols, respectively. Conclusion: Jet injectors generate a high number of small-droplet aerosols, potentially introducing harmful effects to patients and healthcare personnel. Room ventilation and smoke evacuation are effective safety measures when chemotherapeutics are used in clinical practice.

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“…Viruses are 0.01 to 0.3 μm (10–300 nm) in size. Both HPV 19,20 and HBV viruses 21 have been identified in surgical plume, while bacteria have also been grown in culture from laser plume 22 . However, despite case reports, 23 there is little hard evidence of actual viral transmission, despite the concerns around HPV in particular 24 .…”

Section: Is It Dangerous?mentioning

confidence: 99%

Clearing the air on surgical plume

Watters

Foran

McKinley³

et al. 2021

ANZ Journal of Surgery

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Background Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. Method This paper is a narrative review of potential risks, including any associated with COVID‐19, and options for mitigation. Results Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID‐19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID‐19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. Conclusion The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume.

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Laser Plume From Human Papillomavirus–Infected Tissue: A Systematic Review

Cited by 10 publications

References 27 publications

The dangers of human papillomavirus (HPV) laser plume and best safety practices

The dangers of human papillomavirus (HPV) laser plume and best safety practices

Needle‐free jet injection‐induced small‐droplet aerosol formation during intralesional bleomycin therapy

Clearing the air on surgical plume

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