Dental Infection Control: Pathogens from lasersPLUMES

In 2003, the “Guidelines for Infection Control in the Dental Health-Care Setting” got our “plumes ruffled,” and I don’t mean our feathers.

BY NOEL BRANDON KELSCH, RDHAP

In 2003, the “Guidelines for Infection Control in the Dental Health-Care Setting” got our “plumes ruffled,” and I don’t mean our feathers. The guidelines reminded us of the new recommended methods of treating patients, of all the risks involved, and to develop protocols to keep everyone safe.

As each of us reach for that laser to change someone’s life while delivering state-of-the-art dental care, we need to look closely at the risks, including the plume that arises during treatment. This amazing machine uses light waves that are tissue specific. It can ablate diseased tissue while enhancing the healing of surrounding tissue.

The byproduct of the process of thermal destruction is a laser plume of smoke from the burning of tissue. This aerosol can be visible or invisible. This smoke can contain tissue debris, viruses, particulate gases (benzene, formaldehyde, and hydrogen cyanide, to name a few) and quite frankly, it does not smell good! This can be a risk to dental personnel.

If this plume reaches the nasal mucosa, specific viruses can be issues. There are potential risks involved in being exposed to the plumes that are produced.

If this material contains pathogens that reach the operator, for example through the nasal mucosa, there is the possibility of disease transmission. One study used bovine papillomavirus-induced cutaneous fibropapillomas that were exposed to carbon dioxide laser. The laser setting that was used was within the normal range of clinical settings. The laser plume was then suctioned and collected. It was reinoculated into the skin of calves. As a result, the calves developed the disease.1 This study showed how vital it is to comply with the Centers for Disease Control recommendations and OSHA standards for infection control when using lasers.

The other issue has been addressed by the American National Standards Institute (ANSI), which sets the safety standards for items used in the medical setting. They are concerned that health-care providers may assume that the Nominal Hazard Zone (NHZ) for the laser beam (how far you must be from the beam so as not to incur damage to body tissues) is the same for the plume. ANSI found that the hazard area for plumes may exceed the NHZ for the laser.2 Exposure to these gases can lead to many different symptoms and problems, including nasal congestion, vomiting and nausea, coughing, watery or burning eyes, chest tightness and fatigue, abdominal pain, cramping, and flu symptoms.3

DHCP are exposed to diseases every day. Using precautions, we can all limit the transmission of disease. Here are some simple things we can do to prevent the transmission of disease while using this piece of equipment, or a high speed handpiece that creates aerosols.

1. The first barrier to disease is to keep yourself healthy and not become a suceptible host.
2. ctive equipment worn properly has been proven to limit disease transmission. Masks should filter 0.1 micron, cover the nose and mouth snugly, be single-use, and be changed between every patient or when they become moist. Properly fitted protective lenses that meet the ANSI requirement of the laser you’re using will limit exposure to plume. The plume can extend past the NHZ, so always wear your PPE in the treatment area.
3. The third line of defense is high volume suction (HVS). Studies show that you can effectively reduce the plume by using high volume suction during the procedure. Keep the suction tip close to the procedure to reduce the amount of exposure. If you’re doing the procedure without assistance, consider purchasing a flexible HVS tip or slightly bending your tip.

Having the best possible equipment available to deliver optimal patient care is so important. Knowing what risks are involved and limiting those risks is equally important. RDH

References

1. Viral Disease Transmitted by Laser-Generated Plume (Aerosol), Arch Dermatol.2002;138(10)1303-1307; Garden JM, O’Banion MK, Bakus AD, Olson C.
2. American National Standard for safe use of lasers in health care facilities. Orlando: Laser Insitute of America;2007:19.
3. Laser plumes—Health care facilities. Available at: http://www.ccohs.ca/oshanswers/phys_agents/laser_plume.html. Accessed 8/11/2012t.

NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists’ Association.

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