LASER SAFETY BASIC LASER ENERGY LASER is an

LASER SAFETY

BASIC LASER ENERGY LASER is an acronym for LIGHT AMPLIFICATION BY “STIMULATED” EMISSION OF RADIATION

Early 1900’s, Einstein described a theory that involved stimulation of matter to cause the release of energy. Incident Photon Excited Atom Incident Photon Stimulated Photon same wavelength same direction in phase

Alaskan Lasers ◦ ◦ ◦ ALASKA NATIVE MEDICAL CENTER HOLMIUM, IRIDEX ALASKA REGIONAL HOSPITAL CO 2, HOLMIUM, GREEN LIGHT BARTLETT MEMORIAL HOSPITAL CO 2, HOLMIUM, GREEN LIGHT FAIRBANKS MEMORIAL HOSPITAL CO 2, HOLMIUM MAT-SU REGIONAL HOSPITAL CO 2, KTP, HOLMIUM PROVIDENCE HEALTH SYSTEMS ALASKA C 02, KTP, HOLMIUM, GREEN LIGHT CO 2

TYPES: WAVE LENGTH CO 2 10, 600 CO 2, N 2, He Water nm TYPES OF LASER WAVELENGTH KTP DIODE HO: YAG HE: NE ACTIVE MEDIUM ABSORBED BY USES Gyn, ENT, Plastics ACTIVE MEDIUM 532 nm Nd: YAG (frequency passes thru doubled KTP crystal YAG) Hemoglobin, Melanin Eye, Urologic, Gyn 532 - 908 Seminm conductor Hemoglobin Eye 2140 nm Holmium in YAG Water Urology 633 nm Helium Dark-colored Tissue Visible. Aiming beam

LASER CLASSIFICATION SUMMARY Class 1 Incapable of causing injury during normal operation Class 1 M Incapable of causing injury during normal operation unless collecting optics are used Class 2 Visible lasers incapable of causing injury in 0. 25 s. BAR CODE SCANNERS Visible lasers incapable of causing injury in 0. 25 s unless collecting optics are used Class 2 M Class 3 R Marginally unsafe for intrabeam viewing; up to 5 times the class 2 limit for visible lasers or 5 times the class 1 limit for invisible lasers (RED LASER POINTERS) Class 3 B Eye hazard for intrabeam viewing, usually not an eye hazard for diffuse viewing (MEDICAL LASERS) Class 4 Eye and skin hazard for both direct and scattered exposure MOST MEDICAL LASERS Laser-Professionals. com

CLASS 4 LASER Hazard Classification Class 4 lasers above 500 milliwatts in power can injure you if viewed directly or by viewing either the specular and diffuse reflections of the beam. These lasers can also present a fire hazard. A danger sign will label this laser. Eye and skin protection are required. LASER PROFESSIONALS. COM

Hazards Potential for: Eye Injuries Tissue Burns Plume Inhalation Fire Electrical (To name a few)

TYPES OF LASER EYE EXPOSURE INTRABEAM VIEWING EYE LASER SPECULAR REFLECTION LASER DIFFUSE REFLECTION LASER Laser-Professionals. com REFLECTED BEAM MIRROR SCATTERED LIGHT ROUGH SURFACE

Visible and Near-Infrared Radiation Causes Retinal Burn

Mid and Far Infrared - causes damage to the cornea by increased temperature in tears and tissue water. Consider CO 2 @ 10, 600 nm and the effect on an eye….

MULTIPLE PULSE RETINAL INJURY Laser-Professionals. com

HAZARDS CONTINUED: Ø SKIN – Inadvertent, reflected beam Ø PLUME – Toxic, similar to ESU smoke Ø FIRE – Reflected beam, drape, solutions, methane gas, ENDOTRACHEAL TUBE! Ø ELECTRICAL –HIGH- Voltage equipment ØFluids too close Ø ALEXANDERS CARE OF THE PATIENT IN SURGERY, 2011

• • SAFETY Terminology- NHZ/OD Laser safety officer Safe practice –laser operator Controlled access Signage/ glasses Smoke evacuation Et tube use Fire and electrical safety

Terms: Nominal Hazard Zone (NHZ) This zone describes the region within which the level of direct, reflected, or scattered (diffuse) laser radiation is above the allowable MPE. KEY: Consider ENTIRE OR Room AS NHZ Optical Density (O. D. ) This is the ability of material to absorb light. You will see this on the goggles/glasses.

Who has primary responsiblity for laser safety any time a class 4 laser is operated? The person operating the laser always has the primary responsibility for all hazards associated with laser use. What safety precautions are required?

SAFE PRACTICE & CONTROLLED ACCESS Recommended that there be a dedicated laser operator for each procedure Standby used liberally. Direct conversation between surgeon and laser operator Keep foot pedals separated Signs on all entrances that state type of laser w/ matching glasses ◦ ◦ ◦ Control of traffic in room Entire room considered within NHZ! Windows: Covered (exception – co 2 lasers) Easiest to remember to always cover! OSHA: Key must be removed when laser is not in use!

LASER SAFETY EYEWEAR Eyewear would have prevented most laser eye injuries, but it does not make the wearer invulnerable. It is never safe to stare into a laser beam, even if wearing laser protective eyewear. Laser-Professionals. com

EYE PROTECTION Ø Wavelength/ O. D. Matches type of laser • Do not use color as your choice! Ø Use glasses with side shields Ø Hang with laser signs at each entry Ø Use filters, fixed or semi-permanent, in microscopes Ø Clean/ inspect. Replace if questionable Ø Patient Protection: • Awake – eyewear that matches laser • General – water base lubricant/tape • Nd: YAG – foil type covering/ glasses • Facial resurfacing – special contacts

SURGICAL SMOKE Surgical smoke is generated from use of lasers Hazardous chemical compounds have been noted in surgical smoke Smoke evacuation ◦ Utilize evacuation system for 0. 1 microns w/ filters (ULPA/HEPA) ◦ Use of laser masks (0. 1 Microns) ◦ Hold nozzle close to source of plume ◦ Discard filters as biohazard

ENDOTRACHEAL TUBES Ø FDA approved, non flammable, laserresistant (or wrapped w/ same) Ø Do not use pvc tubes Ø Inflate cuff with saline (tint w/ methylene blue) Ø Externally protect with wet cottonoids Ø Use lower concentration of oxygen (less than 30%) or room air

FIRE SAFETY No alcohol/ no pooling during prep No liquids on machine No flammable ointment on patient eyes Water/saline on field Cover anal area to block methane Fire extinguisher immediately available Endotracheal tube fire: ◦ Disconnect anesthesia gases ◦ Remove tube/ extinguish flames w/ NACL ◦ Ready to do bronchoscopy/ trach Equipment fire: shut off power source

ELECTRICAL SAFETY § Check all cords and cables for defects. No liquids near laser. Foot pedal covered. Extension cords not ever used! Control traffic around cords and fibers. § Emergency shutdown procedure § §

DOCUMENTATION Laser Safety Checklist Laser Log

ELECTROMAGNETIC SPECTRUM Visible Gamma Ray X-ray Short Wavelength Ultraviolet Infrared Radio Microwaves Long Wavelength Lasers operate in the ultraviolet, visible, and infrared. Laser-Professionals. com Radio

LASER COMPONENTS Optical Resonator Active Medium High Reflectance Mirror (HR) Output Coupler Mirror (OC) Excitation Mechanism Laser-Professionals. com Output Beam

Near Ultraviolet – Contributes to certain forms of cataracts Xenon Chloride Excimer: Instant cataract, 308 nm pulsed laser

LASER SAFETY STANDARDS § The Federal Laser Product Performance Standard (FLPPS) of the Center for Devices and Radiological Health (CDRH) This is federal law and applies to the manufacture of lasers. § The American National Standard for Safe Use of Lasers (ANSI Z 136. 1) This is a VOLUNTARY Standard that applies to the use of lasers. It is “recognized by” : The Occupational Safety and Health Administration (OSHA) § IEC 60825 International Standard Laser-Professionals. com

LASER SPECTRUM Gamma Rays 10 -13 10 -12 10 -11 X-Rays 10 -10 10 -9 Ultra- Visible violet Infrared 10 -8 10 -5 10 -7 10 -6 10 -4 Micro- 10 -3 Radar TV waves 10 -2 10 -1 1 10 Radio waves 102 Wavelength (m) LASERS Retinal Hazard Region Ultraviolet 200 300 Visible 400 500 600 Near Infrared 700 800 900 1000 1100 1200 1300 Far Infrared 1400 1500 10600 Wavelength (nm) Ar. F 193 Xe. Cl 308 Kr. F 248 Laser-Professionals. com Ar 488/515 He. Ne Ruby 633 694 2 w Alexandrite Ga. As Nd: YAG 755 905 532 Nd: YAG 1064 Communication Diode 1550 CO 2 10600

WAVE NATURE OF LIGHT l Wavelength Blue: l = 400 nm Light is an electromagnetic wave. Different wavelengths in the visible spectrum are seen by the eye as different colors. Red: l = 700 nm Laser-Professionals. com

LASER CONTROL MEASURES ANSI Section 4. 1 “Control Measures shall be devised to reduce the possibility of exposure of the eye and skin to hazardous levels of laser radiation. ” Types of Control Measures • Engineering • Administrative • Procedural Laser-Professionals. com

LASER HAZARD CLASSES Lasers are classified according to the level of HAZARD that is possible during normal operation. Laser-Professionals. com

Control Measures for Class 3 b and Class 4 Lasers Engineering Administrative PPE Protective housing and service panel Laser safety officer Eyewear Interlocks on the protective housing Standard operating procedures Clothing Limitations on use by class Gloves Door interlocks and remotecontrol connector Beam attenuators and beam shutters Key switch or padlock Filtered viewing optics and windows Emission delay Warning lights, emission indicators Beam enclosure Controlled beam path Laser controlled area Beam stops Remote firing and/or monitoring Entry limitations for visitors Education and training Maintenance and service manuals Marking of protective devices Warning signs and labels THE LASER SAFETY OFFICER (LSO) IS RESPONSIBLE FOR MAKING SURE CONTROL MEASURES ARE IN PLACE

MAXIMUM PERMISSIBLE EXPOSURE Ø MPE limits indicate the greatest exposure that most individuals can tolerate without sustaining injury. MPE depends on Wavelength Output energy and power Size of the irradiated area Duration of Exposure Pulse Repetition Rate Useful for determining optical densities for eyewear, filters or windows.

CHARACTERISTICS OF LASER LIGHT MONOCHROMATIC DIRECTIONAL COHERENT The combination of these three properties makes laser light focus 100 times better than ordinary light Laser-Professionals. com