Global Standards for Laser Safety
Laser technology is now not only limited to the hospital operating rooms, it in fact has also become available in the clinics, private enterprises and the office practices. The burden of the management of safety has shifted to the individual users from that of the hospital staffs, often without the advantage of proper resources. The reason behind such a change is that laser emits coherent and intense electromagnetic radiation which has the potential to cause irreversible damage to both the skin and eye. Laser safety is something that is everyone’s concern. Lasers have the capability of delivering a large package of energy and that too in a very focused and controlled manner; in fact most of the laser applications take the advantage of it (Debord et al. 2014). However, it is also to be noted that if those properties are not controlled in an effective way, they could present severe hazards to the workers working with them and also to the adjacent activities and materials. Like, for example, the risk of burns, eye damage and the risks of material surfaces to get damaged. This paper will present a brief jest of risks, hazards and control measures associated with the laser safety. The main purpose of this report is to provide general information and some practical guidance on the working conditions in an aim to lead to high standards of the safety for all the personnel that are involved in the maintenance and operation of laser devices.
Risk management
Knowledge about the standards, practice guidelines and regulations
The international standards regarding the laser safety are all available through the IEC (International Electrotechnical Commission), documents 60825, 60825- Part 8 and 60601 (Smalley 2013). All these standards are worldwide benchmarks for the laser safety and consist of the informative and normative guidance for the professional clinicians, laser use facility administrator, and manufacturers of the laser use facilities. In some of the countries such as in Australia and Canada, these standards are coordinated with the national standards and are also made mandatory as the starting point for all the professional recommended practices and the additional regulations. The standards are though non-regulatory but they serve as the consensus documents for the best practise. In Australia, the 4173 (guide to safe use of lasers in the health care) and AS/NZ 2211 (Laser safety) has become the standards for the laser safety in all the healthcare centres (Kaushal, Jain and Kar 2017). They have taken on the affect of the regulation through its world wide acceptance. These standards have been incorporated into the state regulations like the ones adopted in Western Australia and Tasmania under the Radiation Safety Act of 1999 (Olsen et al. 2015). Also, in the United States, there are number of states that have regulations needing registration of the laser systems, and proof of the administrative controls as it is defined in the ANSI Z136.3 (American National Standard). These ANSI standards are the base for the laser safety requirements as it is determined by the OSHA (Occupational Safety and Health Administration), the governmental branch of ‘Department of Labour’. They carry the power to issue the legal and citations action for the non-compliance.
Importance of Compliance with Global Standards and Regulations
Similarly, in Europe the guidelines listed in the document of IEC-60825 offers non-regulatory guidelines for the control and identification of the major hazards that are in relation with the medical lasers (Smalley 2013). Also, the document of 60825- part 8 too contains much more informative sections with the expanded illustrative processes that are focused on the laser users and is indeed a very helpful for the safety management and policy development (Oswal, Moseley and Smalley 2014).
The laser users must possess working knowledge about all the technical materials which included the nominal ovular hazard area, the limits of exposure, classifications etc. The clinicians can make use of the services of the medical physicist, a LPA (Laser Protection Advisor), a LSO (Laser Safety Officer) or any company that is specialised in the laser safety in order to assess technical issues such as accident investigation.
Identification of the Risks and Hazards
To assess the potential risks and hazards of the exposure to the hazardous levels of laser emission, it is very important for both the operator and the user to have thorough knowledge and understanding of the laser science. The laser science includes:
- Properties of the laser light
- The absorbing chromosomes of every wavelength
- Characteristics of the wave length
- Dosimeter (power density, energy density, pulse parameters, power etc)
- Delivery systems, spot size and instrumentation
- Application techniques (medical and surgical)
When all of the above mentioned attributes are nicely understood, clinician could then anticipate the potential risks and hazards and (Parandoush and Hossain 2014). Once the potential hazards are recognised, the risk can be assessed.
Implementation of the control measures and establishing control measures
Control measures are referred to the actions that are taken by the healthcare personnel in order to prevent the exposure or injury to the identified hazards (Hoyos and Zimolong 2014). Once the risks based on the hazards is identified as well as the potential of the exposure to those risks are been assessed, the users could then able to develop control measures as well as implement them. These measures generally translate into the procedures and policies which have clear statement of the scopes and rationale.
Each of the policies must be updated annually, when the new accessories, clinical applications or systems are introduced. It must also consider whenever a new standard or regulation is been published. The main responsibility of the LSO is to enforce the compliance along with all the control measures.
Basically, there are three types of control measures- procedural controls, engineering controls and administrative controls-
- Procedural controls- It refers to the procedures and policies in the healthcare facilities (Nolan 2014). These are mainly the operational activities that are specific to the practice and equipment and they include the flammability hazard prevention, ocular protection, control of the electrical hazards, controlled access, control of the beam emissions, control of the system of delivery and the management of the plume.
- Engineering controls- These are the inbuilt safety features that are provided by the manufacturers who are in compliance with the FDA and IEC standards (McHugh et al 2013). They include guarded footswitch, visible and audible emission, and housing interlocks, stand by controls, beam attenuators and emergency off control.
- Administrative controls- These are the infrastructure of the laser safety program. It is to be noted that they must be in the place right before laser could be used and they include the LSC, LSO, training and education of all the personnel, development of the documentation tools, technical management plan and development of the formal audit (Smalley 2018). There are often reviewed by the OSHA, TJC or the state health departments.
A well written safety plan must be kept in a book mentioned at the laser use site. It must be noted that the book should contain all the policies and procedures along with the safety set up checklists, credentials roster, audit reports etc. It is also to be ensured that each and everyone should become familiar with this book.
Potential Risks and Hazards of Laser Emission
The Laser Safety Officer or LSO is the person who has the responsibility for managing the risk and he has the power to ensure compliance with every applicable rules and standards (Marendaz, Suard and Meyer 2013). Hence, a LSO must to be competent enough to assess all the systems as well as to validate the skills and knowledge of the personnel who are engaged in laser practise. It is to be noted that a LSO could be an infection control officer or an occupational health and safety officer or any safety consultant. He just has to be properly qualified in this field. However, the duties the LSO varies based on the scope and size of laser facility but the standards require LSOs to be responsible for the following:
- Evaluation of the hazard
- Advising the facility administration
- Approving the labels and the signange
- Investigating the incidents and accidents
- Authorization of the service providers and the laser technicians
- Maintaining and approving the protective equipments
- Implement proper control measures
- Ensuring that audits are conducted on a regular basis as well as are documented and followed up
- Ensuring that every staff is well trained and educated on the safety measures (Sliney and Mellerio 2013)
The controlling hazards in the room of laser treatment generally depends on the controlled access to the equipments and room, monitoring the testing operations of the laser as well as its system of delivery and appropriate use of the personal protective devices.
The controlled access is built on the determination or identification of the NOHA (Nominal Ocular Hazard Area) or the NHZ (Nominal Hazard Zone) (Stewart et al. 2013). It is the area in which the exposure level to the laser radiation could exceed MPE (Maximum Permissible Exposure). However, it is to note that both NHZ and NOHA refer to the mathematical calculation.
The levels of the Ocular injury are firm about the interaction with the tissues and the absorption of the chromosomes which are there in the structure that are bare.
The long wavelengths are absorbed by the water in the tissues and therefore, they could be absorbed at the tear layer that covers the cornea of the eye (Sacca, Roszkowska and Izzotti 2013). When water is vaporised away, beam interacts with the cornea’s tissues in order to cause burns. Though it is temporary but still, it can be very painful and can led to temporarily disabling. The mid ranged infrared could partially absorb and still they can partially transmit via water and it also has the potential to cause injury to the lens and cornea, though not to retina (Mallet and Rochette 2013). Furthermore, the short wave lengths penetrate through the water and they can transmit all the structures that are anterior of the eye, thereafter absorbing the haemoglobin present in the retina and causing a permanent damage to the vision of the eye (Taylor et al. 2015).
Control Measures: Procedural, Engineering, and Administrative Controls
Protective eyewear that are specially designed for the management of the wavelength and the classification of laser that are in use must always be worn along with other safety controls which might be in the place in order to make sure that the person would not be exposed to the laser energy that are in surplus of the MPE (Roberts, Kruse and Stoll 2013). Hence, everyone who works in the laser treatment room must wear proper protective eyewear all the times when a laser is in use. The exception to this is only when any physician is working on a filtered microscope
Lasers are the electrical devices and therefore they should be handled with same caution and safety measures as any other electrical device but there are some individual users who completely overlook this matter. It should always be remembered that every electrical safety measures and procedures must be followed as well as a safety plan that is well responsive to the fire must be in the right place and they must include in the staff education programs.
The laser operator must examine the unit during the set up and the testing in order to ensure that all the electrical cords, chargers, connections and plugs are intact and are also in a safe working condition.
Education and Training
Proper education and training equip clinicians with a foundation of information and knowledge is required to establish an environment that is laser safe. It is the responsibility of an individual practitioner or facility to establish criteria that is acceptable and at the same time, is credentialing. Along with this, some courses that offers written tests and validates certain knowledge level must be validated with the own equipments of the users in a proper manner in their clinical workplace. It is to be ensured that the education that is to be provided to the users must be an on-going process in order to stay in track with the technology through conferences, networking, professional organisations and journals.
Documentation
Of all the safety procedures and measures, the most important is the documentation and it should become one of the priorities. Audit reports, logos, policies, operative records, maintenance records and repair everything contribute to the claims that clinician has enforced laser safety practice (Smallwood 2013). In absence of accurate documentation, there is no sustainable support or factual objective for that claim. Incomplete and inaccurate documentation is an area that falls under the liability for most laser clinicians all round the world. Much more attention is being placed on the compliance with the known standards of safety, and compliance with and knowledge of, standards is an indispensable. Hence, documentation is very important to include in formal audit process along with an emphasis on identifying the areas that are not being completed accurately with the mentioning of the recommendations for the remedies as well.
Responsibilities of Laser Safety Officer (LSO)
Conclusion
To sum up it can be said that lasers are potent to produce powerful beam of light that can harm the eye permanently and generate any other associated hazards. The lens of the human eye concentrates on the light energy through focusing the light on small part of the retina and the result could be microscopic burn that can cause permanent or temporary blind spot on the eye. Hence, it is very important to take proper safety measures in order to avoid such conditions.. The safety precautions must include every control measures and knowledge about the safe laboratory design along with personal protection equipments.
References:
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