SAVANNAH, Georgia — Exposure to surgical plume, the aerosolized byproduct that can be emitted during electrosurgery and laser-based procedures, occurs frequently for clinicians and staff, but knowledge about safety protocols and about the substance itself is low, new research suggested.

In a single-center survey study of 53 participants involved with procedures that could generate plume, 47% reported experiencing exposure at least five times per week; yet 72% said awareness about possible associated problems was “lacking” at their institution.

At baseline, recognition of visible components of the plume, such as tissue particles, was high, but awareness of biological hazards such as bacteria was lower.

After participants viewed a brief video presentation, there was a significant increase in both overall knowledge and recognizing specific hazards — and 91% of respondents said they would support routine safety measures at their own practice. However, many cited barriers to doing so.

“There is still room for further research in order for us to get a good baseline understanding of what exposures in outpatient settings look like in terms of quantity and about the subsequent concerns for physicians and staff,” investigator Gerardo Guilarte, research fellow in the Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, told Medscape Medical News.

Guilarte reported his findings at The American Society for Laser Medicine and Surgery (ASLMS) 2026 Annual Meeting.

Pragmatic Barriers?

Plume/smoke is created during the heating and destruction of tissue during laser-based procedures “and is increasingly recognized as a meaningful occupational exposure in procedural care settings,” the investigators noted in their abstract.

“Contemporary reviews describe plume as a complex mixture that can include volatile organic compounds and other toxicants, particulate matter (including ultrafine particles), and biologic material, with potential short-term irritant effects and uncertain long-term health implications for exposed personnel,” they wrote.

They added that the ultrafine particles that are generated could potentially enter deep into the respiratory tract, reinforcing the need for protection protocols.

National Institute for Occupational Safety and Health (NIOSH) recommendations include the use of such measures as exhaust ventilation and smoke evacuation to reduce plume exposure. “NIOSH research has shown airborne contaminants generated by these surgical devices can be effectively controlled,” the organization noted on its website. 

However, previous research has shown that implementation across centers remains inconsistent, with knowledge gaps and “pragmatic barriers” often leading to impediment of routine adoption, the current investigators wrote. For their study, they sought to assess knowledge on these topics both at baseline and after participants underwent a brief educational intervention.

The prospective study enrolled 58 clinical personnel from the University of Pittsburgh’s dermatology department — all of whom had direct exposure to plume-generating procedures. All participants completed an electronic survey at baseline and again after viewing a short video presentation.

Among the 53 participants who filled out both surveys (91.4%), 15 were dermatology residents and fellows, 12 were attendings, 10 were physician associates, and 16 were support staff.

The educational intervention consisted of a 9-minute video about plume composition and health risks, mitigation strategies, and recommended personal protective equipment and evacuation systems.

Inadequate Institutional Awareness

At baseline, only 11% of the participants said they believed institutional awareness of surgical plume and its potential hazards was “adequate.” Although recognition of tissue particles was high (91%), only 57% were aware of bacteria as a biological hazard of the plume.

Additionally, clinicians had a higher awareness of the overall health hazards of the plume at baseline compared to support staff (P = .003).

Overall knowledge increased significantly for the full study population from baseline to post-intervention (P < .001). There were also significant increases in recognizing the hazards of bacteria, chemical toxins, and viruses (P < .001 for all). 

After the educational intervention, 91% of participants said they were likely to support the implementation of routine safety measures, and 55% said they actually planned to make immediate practice changes.

However, 51% reported having significant implementation barriers, especially a lack of evacuation equipment (82%), an absence of institutional policy (63%), or time constraints during procedures (48%). Finally, 49% cited the importance of standardized clinical protocols regarding plume protections, and 71% wanted further resources, including continuing medical education and information sheets.

Overall, “a short, scalable training [program] can rapidly strengthen shared understanding, an essential foundation for consistent safety practices in busy outpatient procedural workflows,” the researchers wrote.

However, Guilarte said at the meeting, “pairing education with the proper protocols and access to the most reliable equipment and supplies would be important moving forward.”

‘Major Problem’

Session moderator Chris Robb, MD, PhD, co-founder of the Skin & Allergy Center in Tennessee, called surgical plume “a major problem” within the field.

“There’s a real lack of awareness about its danger, even though we’ve known for years that there’s a risk factor to keep in mind. So I’m glad the investigators are making some strides towards increasing awareness,” Robb said.

He added that some study respondents felt their centers lacked knowledge about these problems, which could be institution-based. “I think most universities do a better job of being aware of this problem than private practices do,” Robb said.

This difference was further highlighted when Medscape Medical News talked to several other clinicians about how the issue of surgical plume is treated at their own institutions.

Zakia Rahman, MD, clinical professor of dermatology at Stanford University School of Medicine, Palo Alto, California, reported that her large healthcare system has laser safety officers and committees for all types of issues, including eye safety, fire hazards, and plume. 

On the other hand, E. Victor Ross, MD, director of the Scripps Clinic Laser and Cosmetic Dermatology Center, San Diego, said that although his center has a laser safety monitor, that person doesn’t really check on the plume. Instead, Ross and his staff are mostly in charge of their own monitoring during procedures.

“We try to be as careful as we can, but sometimes, the plume does get out into the environment no matter what your best efforts are,” he told Medscape Medical News.

Taryn Murray, MD, of the Laser Surgery and Cosmetic Dermatology Department at the Cleveland Clinic, Cleveland, noted that her center has strict regulations with regard to certain procedures that are only allowed to be performed in specific rooms. “That’s because we have different levels of air filtering systems. But we also have smoke evacuators in every room,” she said.

Still, “It’s up to the individual person doing the treatment whether they’re taking the appropriate steps and making sure everyone is protected. As someone who does several of these treatments every day, I take it very seriously,” Murray said.

Tips and Recommendations

Ross noted that his key recommendations for clinicians include wearing a mask and “keeping the handpiece close to the source,” but that can sometimes be difficult.

“Although plume reduction devices are sometimes integrated in the handpiece, which is ideal, that can add weight to the handpiece. In a perfect world, someone would develop an integrated plume reduction system that would also be ergonomically pleasant to use,” he said.

“But overall, if you smell the plume, your plume reduction is probably inadequate,” Ross added.

Rahman, who directs the laser and aesthetic clinic at Stanford and is a member of the ASLMS national board of directors, noted that although several risks exist, one of the most concerning is a link between surgical plume and human papillomavirus (HPV).

“Published reports have shown that laser surgeons or others that do electrocautery can get HPV-related squamous cell carcinoma or HPV after prolonged exposure. So, I encourage people to get the nonavalent vaccine,” Rahman told Medscape Medical News.

“If you’re a healthcare provider and you’re doing procedures that have surgical plume, you can have your doctor submit to get coverage. HPV is one of the most dangerous risks, but it’s also one of the most preventable,” she said.

Guilarte, Robb, Rahman, Ross, and Murray reported having no relevant financial relationships.