With no evidence of HPV infections from surgical smoke, CDC holds off on N95 respirator recommendation

January 12th, 2015

Surgical smoke plumes can contain intact viral DNA, but with no definitive evidence of transmission of infections a federal advisory panel recently decided not to recommend the use of N95 respirators during certain smoke-generating procedures.

The issue before the Healthcare Infection Control Practices Advisory Committee (HICPAC), an expert advisory panel to the Centers for Disease Control and Prevention, related to laser and electrocautery pro­cedures for Human Papilloma Virus (HPV), such as smoke-producing procedures to remove HPV warts.

A CDC research review of 25 articles found evi­dence of whole HPV genome in smoke plume. In one study, viable bovine papilloma virus was generated in smoke plume and then injected into cows. All three of them acquired the infection.

But that didn’t mimic occupational exposure, and other studies did not clearly show a link between occupational exposures and HPV infection, David Kuhar, MD, medical officer with CDC’s Division of Healthcare Quality Promotion, told Hospital Employee Health.

“The epidemiology of disease is not here,” says Kuhar. “With that piece missing, it makes it difficult to say there’s disease transmission happening, because it hasn’t been demonstrated.

Case reports also are lacking, he says. “We’ve had 20 years of these exposures happening and no clear signal of disease,” he says.

The hazards of surgical smoke have long been a concern of peri-operative nurses. The Association of peri-Operative Registered Nurses (AORN) recommends the use of smoke evacuation systems for electrocautery and laser procedures and says facilities “should consider” N95 respirators as personal protective equipment when procedures involve infectious material.

--Michele Marill

For more on this story see the January 2014 issue of HEH