Safe use of lasers in the operating room: what perioperative nurses should know

AORN Journal,  Jan, 2004  by Karen Andersen

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ABSTRACT

* SAFETY HAZARDS are inherent in laser use, but they can be eliminated or significantly reduced with adherence to proper procedures.

* THIS ARTICLE reviews beam-related and non-beam-related safety hazards, including eye injuries, fire and thermal injuries, smoke plume, and electrical hazards, as well as safety measures to avoid these hazards.

* EDUCATION IN LASER SCIENCE and safety is key to recognizing potential hazards and ensuring that safety parameters are followed. AORN J 79 (January 2004) 171-188.

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Every year, laser accidents occur that could have been prevented if appropriate policies and procedures had been followed. The primary responsibility of a perioperative nurse during a laser procedure is keeping the patient safe. Safety hazards are inherent in laser use, but they can be eliminated or significantly reduced with adherence to proper procedures. When perioperative nurses are educated in laser science and safety, they can recognize potential hazards and ensure that safety parameters are followed. This article details the current standards for laser safety and addresses both beam-related and non-beam-related hazards.

STANDARDS AND REGULATIONS

There are no federal requirements for safety during laser procedures, but there are recognized national standards. The key source of safety standards for laser use is the American National Standards Institute (ANSI) which publishes standard Z136.3, "Recommended practices for laser safety for health care facilities." (1) All facility policies and procedures should be based on ANSI standards. Hospital ORs, surgery centers, and physician practice-based surgery suites are expected to comply with the recommended safety standards.

The Occupational Safety and Health Administration (OSHA) also has an interest in laser safety, particularly concerning the safe evacuation of smoke created by lasers. Only OSHA has the full force of the law behind its regulations. The General Duty Clause permits OSHA to cite employers for not providing "employment and a place of employment which are free from recognized hazards." (2) This agency also has the authority to regulate smoke in the workplace under the respiratory protection program (ie, 29 CFR 1910.134), which addresses personal protection equipment and engineering controls, such as smoke evacuators and ventilation systems. (3) The Occupational Safety and Health Administration has established maximum permissible levels or threshold limit values of surgical smoke and aerosol based on the recommendations of the American Conference of Government and Industrial Hygienists. (4)

The National Institute for Occupational Safety and Health (NIOSH) is a federal research agency that has no regulatory power but is recognized as a leading authority on airborne pollution as it relates to the workplace. This agency has determined that there is a potential hazard to OR personnel from smoke generated by lasers and has isolated formaldehyde, hydrogen cyanide, and benzene in surgical smoke emitted from lasers. This prompted NIOSH to issue recommendations for the use of smoke evacuator units, preferably vented to the outside, and protective equipment (ie, masks, gloves) to be worn by personnel servicing or changing filters on smoke evacuators. (5)

The US Food and Drug Administration (FDA) and the Center for Devices and Radiological Health regulate which lasers are allowed on the market. These agencies also regulate which procedures can be performed by the lasers and the ancillary supplies, including fibers and hand pieces, that can be sold.

AORN addresses laser safety in "Recommended practices for laser safety in practice settings" in its Standards, Recommended Practices and Guidelines, which is published yearly. Although standard Z136.3 is the recognized national standard for laser safety in health care organizations, AORN standards are widely recognized as the optimal standards of perioperative nursing practice. For the most part, both sets of standards communicate the same information regarding laser safety and strongly promote laser safety education and training for all individuals present during a laser procedure, individuals must complete this training before they are assigned to a laser procedure. Yearly reinforcement of the information and recredentialing also are recommended. (6)

LASER CLASSIFICATIONS

Per ANSI requirements, laser manufacturers must classify lasers according to their potential to cause biological damage and the level of hazard inherent in the system. The classification system is based on laser output or power, wavelength, exposure duration, and emergent beam radiant exposure. (1)

CLASS 1. These lasers basically are exempt from the requirements of the laser safety program because the risk of hazard to the operator during normal operation is essentially nonexistent. Lasers in this category include those that operate laser printers and compact disc players.

CLASS 2. Lasers in this category emit energy in the visible range (ie, 400 nm to 700 nm). Laser energy produced by class 2 lasers may be viewed for very brief periods of time but may present potential hazards to the eyes if viewed directly for long periods of time. The light emitted generally is so bright that it is difficult to look into the beam for an extended period of time. The helium neon (HeNe) aiming beam used coaxially with invisible lasers is considered a class 2 laser, as are the laser pointers used in professional presentations.