Course 631 - Hospital Hazards and Solutions: Surgical Suite

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Laser Usage in a Surgical Suite

Introduction

Although there are hundreds of different types of lasers, only about a dozen laser systems are found in everyday clinical use. Employees are exposed to lasers used in healthcare facilities during diagnostic, cosmetic, preventive, and therapeutic applications. Nearly all laser products used in surgery are Class 4. They are designed to deliver laser radiation for the purpose of altering biological tissue.

Laser Classifications

Federal regulations require manufacturers to classify medical laser systems based primarily on their ability to cause damage to the eye and skin. This classification must be indicated on the laser system’s label.

Let’s now take a look at the various types of laser classifications.

Class 1

A Class 1 laser system is considered to be incapable of producing damaging radiation levels during normal operations. This system is also exempt from any control measures or other forms of surveillance. Although some Class 1 laser systems emit very weak, non-hazardous beams, most incorporate “embedded” higher-power lasers. These lasers can only be accessed if important safety features, such as interlocks, are defeated or deliberately bypassed.

Class 1M

A Class 1M laser system is also considered incapable of producing damaging radiation levels during normal operations unless the beam is viewed with an optical instrument, such as a telescope.

class 2
Class 2 and higher lasers must have the laser radiation warning label.

Class 2

A Class 2 laser system emits in the visible portion of the spectrum. Eye protection normally occurs with an aversion response, such as the closure of the eyelid, eye movement, or movement of the head to avoid an exposure to a bright light. The aversion response to a bright visible laser source limits the exposure of the retina to .25 seconds or less.

Class 2M

A Class 2M laser system emits in the visible portion of the spectrum. Eye protection normally occurs with an aversion response for unaided viewing. However, viewing the beam with optical aids is potentially hazardous.

Class 3R

A Class 3R laser system is potentially hazardous under some direct and shiny or mirror-like viewing conditions if the eye is focused and stable. The probability of an actual injury is small. This laser will not pose either a fire hazard or diffuse reflection hazard.

Class 3B

A Class 3B laser system may be hazardous under direct and specular viewing conditions, but is normally not a diffuse reflection or fire hazard.

Class 4

A Class 4 laser system is a hazard to the eye and skin from the direct beam, and may pose a diffuse reflection or fire hazard. This type of laser system may also produce laser-generated airborne contaminants and hazardous plasma radiation.

Safety Issues

When lasers are introduced into a healthcare environment, professionals must be prepared to address safety issues for both the staff and patient. Safe use of these systems requires an understanding of the engineering, training, and administrative requirements for all elements of a healthcare system as well as the risks associated with use of laser light.

All medical lasers are regulated and federal regulations require manufacturers to classify the medical laser system based primarily on its ability to cause damage to the eye and skin. This classification must be indicated on the laser system’s label ranging from Class 1 (no hazard) to Class 4 (serious hazard).

Potential Hazard

  • severe eye injuries from direct or reflected laser beams
  • skin burns from the direct beam of surgical lasers when misdirected
  • respiratory hazards when breathing laser-generated airborne contaminants (LGAC)

In the next tab, we will take a look at the possible solutions to protect yourself from medical laser hazards.

Possible Solutions

goggles

The American National Standard Institute (ANSI) Z136 series of laser safety standards covers lasers in medical settings and provides guidance for the safe use of lasers in healthcare facilities. These guidelines are considered to be the standard for safe practice in the industry and include solutions such as:

  • Use laser protective eyewear that provides adequate protection against the specific laser wavelengths being used. All laser eyewear must be marked with Optical Density (OD) and laser wavelength.
  • Display warning signs conspicuously on all doors entering the Laser Treatment Controlled Area (LTCA) to warn those entering the area of laser use. Warning signs should be covered or removed when the laser is not in use.
  • Facility-authorized technicians who are trained in laser service must perform maintenance on lasers and laser systems.
  • Provide local exhaust ventilation with a smoke evacuator or a suction system with an in-line filter to reduce laser-generated airborne contaminants (LGAC) levels in laser applications.
  • Use an appropriate filter or barrier which reduces any transmitted laser radiation to levels below the applicable Maximum Permissible Exposure (MPE) level, for all facility windows (exterior or interior) or entryways located within the Nominal Hazard Zone (NHZ) of a Class 3B and Class 4 laser system.
  • Use skin protection if repeated exposures are anticipated at exposure levels at or near the applicable MPE limits for the skin.

Training

Detailed training in laser safety should be provided for those healthcare personnel using, or working in the presence of Class 3B and Class 4 health care laser systems. All training activities should be documented and retained on file. Laser safety training should be presented to the following healthcare personnel:

  1. Laser Safety Officer (LSO)
  2. users
  3. laser technical support staff
  4. nurses and allied health personnel

Credentialing

Each medical specialty has evolved its own procedures for bringing in new techniques and new surgical procedures. In all cases, the laser user should use the laser for its intended purpose within the user's scope of practice, training and experience. All credentialing processes must require training in the safe clinical use of the laser, as well as the maintenance of a safe environment in compliance with defined standards, and local, state and federal requirements.

Video

Instructions

Before beginning this quiz, we highly recommend you review the module material. This quiz is designed to allow you to self-check your comprehension of the module content, but only focuses on key concepts and ideas.

Read each question carefully. Select the best answer, even if more than one answer seems possible. When done, click on the "Get Quiz Answers" button. If you do not answer all the questions, you will receive an error message.

Good luck!

1. Nearly all laser products used in surgery are _____.

2. Eye protection normally occurs with an aversion response, such as the closure of the eyelid, in which type of laser?

3. A _____ laser system is potentially hazardous under some direct and shiny viewing conditions.

4. All laser training activities should be documented and retained on file.

5. Class 2 and higher lasers must have a _____.


Have a great day!

Important! You will receive an "error" message unless all questions are answered.