Recommended practices for laser safety in practice settings

AORN Journal,  April, 2004  

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The following recommended practices were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed recommended practices for comment by members and others. They are effective Jan 1, 2004.

These recommended practices are intended as achievable recommendations representing what is believed to be an optimal level of practice. Policies and procedures will reflect variations in practice settings and/or clinical situations that determine the degree to which the recommended practices can be implemented.

AORN recognizes the numerous types of settings in which perioperative nurses practice. These recommended practices are intended as guidelines adaptable to various practice settings. These practice settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive procedures may be performed.

PURPOSE. These recommended practices provide guidance to assist practitioners in providing a safe environment for patients and health care workers exposed to a laser environment. This document incorporates activities described in the American National Standards Institute's (ANSI's) American National Standard for the Safe Use of Lasers in Health Care Facilities, which specifies standards for the use of class 3 and class 4 laser devices in the health care environment. Health care facilities are encouraged to obtain a copy of the ANSI document and have it readily available for reference in the practice environment.

RECOMMENDED PRACTICE I

A laser safety program should be established for private practitioners and/or health care facilities.

1. According to ANSI, facilities in which laser procedures are performed must develop a laser safety program to include, but not be limited to,

* delegation of authority and responsibility for supervising laser safety to a laser safety officer;

* establishment of use criteria and authorized procedures for all health care personnel working in laser nominal hazard zones;

* identification of laser hazards and appropriate control measures;

* education of personnel (ie, operators and others) regarding assessment and control of hazards; and

* management and reporting of accidents or incidents related to laser procedures, including action plans to prevent recurrences.

2. Incidents of safety regulation violation should be reported to the laser safety officer and reviewed by the safety committee. (1)

3. People working in a laser environment should have knowledge of the established laser safety program.

RECOMMENDED PRACTICE II

Personnel working in laser environments should demonstrate competency commensurate with their responsibilities. Education programs should be specific to laser systems used and procedures performed in the facility.

1. Program criteria and content should be in accordance with applicable standards; the facility's policies and procedures; and federal, state, and local regulations.

2. Personnel should be required to demonstrate laser competency periodically and when new laser equipment, accessories, or safety equipment is purchased or brought into the practice environment.

3. The laser safety program should provide participants with a thorough understanding of laser procedures and the technology required for establishing and maintaining a safe environment during laser procedures.

4. Educational activities should be documented and maintained on file in the facility. (1)

RECOMMENDED PRACTICE III

All people should know where lasers are being used, and access to these areas should be controlled.

1. A nominal hazard zone (ie, the space in which the level of direct, reflected, or scattered radiation used during normal laser operation exceeds the applicable maximum permissible exposure) should be identified to prevent unintentional exposure to the laser beam.

* The laser safety officer can determine the nominal hazard zone with reference from ANSI Z136.1 and ANSI Z136.3, as well as the safety information supplied by the laser manufacturer. (1)

* The nominal hazard zone usually is contained within the room but may extend through open doors and/or transparent windows, depending on the type of laser used.

* Personnel in the nominal hazard zone should be aware of all laser safety precautions that are implemented to avoid inadvertent exposure to laser hazards. (1)

2. Regulation laser signs should be placed at all entrances to laser treatment areas when these areas are in service.

* Recognizable warning signs specific to the type of laser being used should be designed according to the information described in American National Standards for Safe Use of Lasers in Health Care Facilities. (1)

* Warning signs should be placed conspicuously to alert bystanders of potential hazards.

* Signs should be removed when the laser procedure is completed. (2)

3. Doors in the nominal hazard zone should remain closed, and windows, including door windows, should be covered with a barrier that blocks transmission of a beam as appropriate to the type of laser being used. (2)