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Laser Safety.

Introduction

Lasers are used in the operating theatre for urology, ophthalmology and gynaecology to name a few specialties and are known to reduce perioperative blood loss, decrease postoperative discomfort, reduce the chance of wound infection, decrease the spread of some cancers, minimise the extent of surgery in some cases and promote better wound healing.

But the use of lasers comes with some unique workplace health and safety issues that are the responsibility of everyone in the operating theatre.

When the users and operators of lasers are not educated and competent in their use, these devices are dangerous pieces of equipment and the adverse outcomes can be devastating for patients and practitioners alike. Two cases of operating room incidents for patients have involved fires in gynaecology cases. One was a drape fire (ECRI Institute, 1992) and the other the ignition of flatus (The New York Post, 2016). Both cases resulted in significant burns for the patients.

Other potential hazards include plume, eye injury and burns to the skin. In this article Bravura Education's Managing Director, Adjunct Associate Professor Elissa O'Keefe, Registered Nurse and Nurse Practitioner helps to get your operating theatre compliant by guiding you through some of the things you need to have in place to meet the new Australian and New Zealand (AS/NZ) Safe use of lasers and intense light sources in health care standard AS/NZ 4173:2018 (Standard Australia, 2018).

New Standard Framework

The safe use of laser devices currently sits within the framework of the principles and legalities of safe work practices and is within the remit of Worksafe New Zealand principles. All health professionals are already familiar with their safe work responsibilities and are held accountable to them too. The new national Australian and New Zealand Standard AS/NZS 4173:2018 Safe use of lasers and intense light sources in health care (Standard Australia, 2018) has been published and now is the time to audit your clinical governance to have a compliant operating theatre.

This standard and the mandatory elements of the document are clear about what is expected of operating theatres, managers and staff alike. The new standards provide a framework to implement strategies to keep staff, patients and hospital visitors safe from non-ionising radiation and are also a valuable resource to have available on site. A common question about these standards though is whether they are mandatory? The short answer is "not necessarily", but the long answer is that it is well worth a closer look.

Firstly, if the standards are written into legislation or regulation then they are mandatory. Where they are not, and an instance of legal action is brought against a doctor, nurse or hospital for negligence or otherwise, the adherence to standards will always be looked upon favourably. For example, a clinician who injures a patient through the use of a laser who has not complied with AS/NZS4173:2018 is more likely to be viewed as negligent than where all relevant standards have been adhered to. So, implementing a radiation safety protection plan for your operating theatres is an essential risk management strategy for both the staff and the facility.

Laser safety programmes should be practical, applicable to the type of procedures undertaken and sustainable in the long term. There are four primary areas that require attention under the new standards which are:

1 Laser education;

2 Competency in the use of lasers;

3 Mitigating risk and protection from hazards;

4 Regular audit.

Do your laser users and operators understand what they are doing and why?

It is mandatory under the new standards that anyone who is a Class 4 laser user or operator has laser safety education. The standards state that "staff shall be trained in operating procedures, including handling and care of equipment, set-up, intraoperative monitoring, use of the controls and delivery systems, and use of all accessory equipment" (Standards Australia, 2018).

Sometimes this education is done in-house, sometimes it is outsourced--and online learning is becoming more and more popular as it does not require staff to be sent away from the workplace and study can be accommodated within the time constraints of busy theatres. Additionally, maintaining an in-house programme can be time and resource intensive and often falls to the same individuals to take carriage of it.

Personnel Training

The standards are explicit too about who needs education and training and it is beyond just users and operators and includes anyone who has contact with these devices. The standards define these people as follows:

1 laser safety personnel;

2 laser users, e.g. surgeons, physicians, dentists, nurses and other allied health professionals;

3 laser team members, e.g. laser operators, biomedical engineers, technicians, medical physicists;

4 laser system service personnel, including either in house or contractor service personnel;

5 incidental personnel, including medical photographers, observers, students, family members and industry representatives.

Remember too that not all courses that have been completed are going to be current and meet the requirements set out in the standards. In fact, if your staff have not done laser safety education this year, we recommend a refresher course because the new standards are just that, new, and have only been released since April 2018. The requirements are that education courses include many specific elements, some of which are not covered by all courses. According to the informative section of the standards, the courses are to have subjects on the operational characteristics of lasers, hazards, and principles and procedures for safe use.

Are your staff capable?

After education, the next most important area to have processes and policies in place is with regard to competency in the use of lasers. What is clear within the standards is that there is an expectation that the criteria for education, training and competency assessment is explicit in your workplace. Your operating theatre should have a policy that is clear about what laser safety education is expected and the process from induction through to the independent use of these devices. It needs to provide direction on who will supervise practice, a progressive list of skills and attributes required and how competency will be assessed and signed off.

Does your hospital have the right clinical governance in place?

The most common method of reducing risk and protecting against hazards is the implementation of standard operating policy and procedure documents in the workplace that are then adhered to by all staff. The most common ones that are relevant to laser practice are:

1 Ocular/eye safety;

2 Controlled access to laser rooms;

3 Laser generated airborne contaminants (plume);

4 Test firing carbon dioxide lasers;

5 Handling a fibre-optic delivery system;

6 Roles and responsibilities of the Laser Safety Officer;

7 Radiation Safety Protection Plan;

8 Criteria for education, training and competency assessment;

9 Flammability hazards and fire safety;

10 Infection control;

11 Incidents and accidents;

12 Equipment inspection.

Auditing requirements

Have you got it all right?

The standards recommend that laser safety audits be completed annually or more frequently if required. Elements of an audit will include: a gap analysis of staff laser safety education with an intent to educate or refresh staff, having a current laser safety plan, the mitigation of risks including eye injury, plume and fire, documentation and observation of practice. There is a sample checklist for audit included as an appendix in the standards to make this process easier for you to complete in your workplace.

Laser clinical governance need not be too hard, if you're interested in talking to someone about the needs of your hospital, please feel free to contact Elissa O'Keefe at elissa.okeefe@bravura.edu.au

References

ECRI Institute (1992). The Patient is on Fire! A Surgical Fires Primer. Guidance 21(1):19-34. http://www.mdsr.ecri.org/summary/detail.aspx?doc_id=8197

New York Post (2016). Woman badly burned after farting during surgery. https://nypost.com/2016/11/01/woman-badly-burned-after-farting-during-surgery/

Standards Australia (2018) AS/NZ 4173:2018 Safe use of lasers and light sources in health care. To purchase a copy of the standards: https://infostore.saiglobal.com

By Elissa O'Keefe

About the author: Adjunct Associate Professor Elissa O'Keefe is a Nurse Practitioner, a health industry pioneer, a highly-experienced clinician and educator and was the first nurse practitioner in the Australian Capital Territory (ACT). She has published in peer-reviewed journals both nationally and internationally and is often called on for comment in the health industry.

Bravura was born when Elissa recognised that there was a need for flexible, high quality post-graduate continuing professional development for health professionals with regard to lasers and other light-based and therapies that was evidence-based and pitched at the high level required of this complex landscape.
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Article Details
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Title Annotation:professional; safety standards for using medical lasers in perioperative setting
Author:O'Keefe, Elissa
Publication:The Dissector: Journal of the Perioperative Nurses College of the New Zealand Nurses Organisation
Article Type:Report
Geographic Code:8AUST
Date:Dec 1, 2018
Words:1444
Previous Article:Professional Nursing Adviser report.
Next Article:Communication is the key.
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