▶ Previous Artlcle : #2-1. Understanding and Safe Use of Surgical Laser

 

Safety Measures for Laser Use

Lasers go though various safety assessments, including usability, risk management and software validation, from the development phase. Especially for high output surgical laser, nominal hazard zone (NHZ), the space within which the level of the direct, reflected or scattered radiation operation exceeds the applicable MPE, should be determined in the process of development and manufacturing and be published in the user manual.

 

Risk management or safety measures for safe laser use should be able to protect user (medical doctor), patient or technical support staff properly in the case of unintended exposure to laser beam. General management method can be classified to administrative control and engineering control.

 

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Protective eyewear and clothes should be worn at all times to create a safe operation room environment. It is most important to protect the eyes by wearing protective eyewear, the representative protection. Different protective eyewear should be used depending on the type and wavelength of laser. It works as a filter against particular part or wavelength so that the current wavelength could not be penetrated. Because penetration may occur depending on the laser output, it is necessary to understand optical density (OD), or absorbance. Higher OD level generally has low transmissivity; OD 1 reduces transmissivity by 10 times, OD 2 by 100 times and OD 10 by 1010 times.

In terms of skin risk management, it is advisable that both patient and user wear fire-resistant clothes and gloves to avoid skin exposure other than the procedure site. Exposing the skin excessively or for a long time to a high output laser beam is not good. Special care should be taken for the possibility of skin cancer from long-term exposure, with recently increased utilization of UV laser.

Other than the direct risk factors on the eyes and skin, surgical laser is also associated with risk factors not directly related to laser beam. One of the most common one is fire, which may happen by chance exposure of flammable materials, such as alcohol, to laser beam inside a norminal hazardous zone.

Next is electrical risk factor. Because high output laser has build-in power supply, it is recommended to place some space between the device to the wall. It is also necessary to use a power cord of a standard length and periodically check the devices for safety, such as foot switch.

Because a laser consist of electronic circuits, electrostatic discharge is also a factor to be looked after. Electrostatic discharge occurs frequently especially in the winter when the humidity is low. The subtle scent that occurs when making a tissue incision or coagulation with a surgical laser is caused by airborne contaminants. Since toxic odor and smoke can irritate the eyes and the respiratory tract, it is wise to wear a mask or to use a smoke exhauster with a built-in filter of fine particles, during laser operation. Other risk factors include the possibility of exposure to chlorine compounds or dye that are used for particular lasers, and the risk of the explosion of compressed gas container.

 

Table 2. Management of Laser

 

Precautions for Laser Use

 

Lastly, let’s sum up several precautions to be made when using a laser.

The first is that the user (medical doctor) should read and fully understand the user manual before operating the device, and should be fully trained for relevant expertise. The possibility of risk should be always kept in mind.

Before use, the device should be checked to see if it is operated normally. Laser should be used for medical purpose only, and a laser warning should be attached on the entrance to the operation room. While using a laser, the user should pay attention to not let the laser beam is exposed to outside the operation room. The operation room should be tied up so that the laser beam would not be reflected by glass or mirror. Everyone with the possibility of direct exposure to laser beam, including the user, nurse and patient, should wear a protective eyewear.

In order to prevent any safety accident, flammable material should not be placed near the device, temperature, humidity and ventilation should be well controlled in the operation room, and the operation room should not be exposed to any chemicals or compressed gas. Electric facilities should be checked if the power frequency, voltage and permissible current (or power consumption) are normal. It is wise to request periodical inspection and repair to the manufacturer.

 

-The End-