Laser Safety Practical Application Seminar

Laser Safety Practical Application Seminar PAS Session 3: Medical Laser Safety - From the Operating Room to the Day Spa Cathi Scogin Course Instructor Monday, 3:40PM Room: Salon A-D

1 Medical Laser Safety From the Operating Room to the Day Spa Cathi Scogin, R.N., CLSO, CMLSO Glendale, Inc. An Understanding Of: Roles and Responsibilities of having a laser Laser Hazards and Safe Work Practices ANSI Z136.3 Intense Pulsed Light and LED sources Patient/ Client options Objectives - DEFINITION L A S E R Light Amplification by Stimulated Emission of Radiation

2 Definition I Intense P Pulsed L Light Not collimated light like a laser, but extremely bright Laser Safety - Laser Safety Officers Protective Eyewear - LSOs should confirm and purchase correct protective eyewear. Other Protective Devices - LSOs review and approve any necessary protective devices (curtains, windows, barriers, beam blocks, etc.) Information and Training - LSOs are the points of contact for laser-related information and training. Laser Safety - Laser Types Continuous Wave (CW) Continuous Wave lasers operate with a stable average beam power. Power remains constant Pulsed or Q-Switched Pulsed beam lasers where the pulse is generated by the resonant mode of the optical cavity or by an intracavity delay which allows storage of potential energy. Power fluctuates up and down. The average power may be less than a particular pulse of power.

3 Laser Safety - Laser Classes There are four general classes of lasers. The classes are normally based on power output. Laser Safety - Laser Classes Class I Not hazardous under normal operating conditions. This class includes many embedded systems. No warning labels or controls are required. < 0.4 milliwatts Laser Safety - Laser Classes Class II Low risk under normal conditions, hazardous only for continuous viewing. A Caution label required. < 1.0 milliwatts Class IIA Low risk under normal conditions, but powerful enough to injure when focused. Various warning labels required.

4 Laser Safety - Laser Classes Class IIIA Lasers are: low risk visible lasers which can cause injury under prolonged intentional exposure or focusing optics. Requires a Danger warning sign. Laser Warning Lights and/or area controls are required (locked door, screened off, etc.). Power: 1-5 milliwatts (CW) Laser Safety - Laser Classes Class IIIB Lasers are: High Risk visible and invisible lasers which can cause accidental injury from direct exposure or specular reflections Also a fire and skin injury hazard. Requires a Danger warning sign. Laser Warning Lights and/or area controls are required (locked door, screened off, etc.). Power: 5-500 milliwatts (CW) Laser Safety - Laser Classes Class IV Lasers are: High Risk visible and invisible lasers which can cause accidental injury from direct, specular or even diffuse beams. Also a fire and skin injury hazard. Requires a Danger warning sign. Laser Warning Lights and/or area controls are required (locked door, screened off, etc.). Power: >.5 watts (cw)

5 Laser Safety - Laser Classes Examples Laser pointers are classified as Class IIIa (the actual power may be higher) A CD player has an imbedded laser and the unit is a Class II. Supermarket Scanners are usually Class II. X-Ray alignment lasers are usually Class I. Construction leveling lasers are Class II or IIIA Medical lasers (skin resurfacing, gallbladder, gynecology, Lasix, dental, heart, orthopedic) are Class IV. Laser Intensity A 1mW laser is more intense than looking at the sun. For Retinal Irradiance: welding arc given a 10.0 irradiance level a 1 mw laser is 100.0 level a 1 Watt laser is 10,000,000 level Laser Safety Bioeffects The parts of the body primarily effected by laser injury are the eyes and the skin. Injury potential is based upon: radiation, wavelength, irradiance, exposure time and viewing conditions.

6 Laser Safety Light Spectrum and Lasers 0 100 200 300 400 500 600 700 800 900 0 1000 1200 ~ 1060 ~2000 ~ 2700 Ultraviolet V i s i b l e measurement in nm Infrared Hazard Regions From 400nm to 1400nm, the eye is 100,000 times more vulnerable than the skin to injury. If the Irradiance entering the eye is 1mW/cm 2 then the Irradiance at the Retina will be 100W/cm 2. UV & middle/ far IR regions of the skin and eyes are equally as vulnerable, however, additional protection for the eye is desirable because of the lasting & more severely incapacitating effects to the eye vs. skin burn Commonly Occurring Causes of Laser Related Incidents Of the 14 major incident categories 1. Unanticipated eye exposure during alignments 3. Available laser eye protection not used 6. Intentional exposure occurred to unprotected persons 10. Incorrect eyewear selection and/or eyewear failure 11. Accidental eye/skin exposures occurred during use. 12. Eye/Skin hazards were produced of a photochemical origin.

7 Laser Incident Database Findings EYE INJURY is by far the most commonly reported laser incident, 281 cases out of 395 incidents, 71% of all reported. 93% involved some vision change 72% produced permanent eye damage 21% has temporary vision dysfunction Nobody has to be injured: with controls and training it doesn t have to happen! Laser Safety - Eye Magnification The human eye can concentrate or magnify light up to 100,000 times, and is most sensitive to GREEN light. Lens Retina Fovea Cornea Macula Laser Eye Damage Can Be Permanent - Wear Your Glasses! Eye Anatomy Cornea - Similar to the skin, has nerve endings, acts as eye s physical protection Lens - Focuses light entering the eye, nonrepairable Iris - Limits light entering the eye, about a 20 ms response time

8 Eye Anatomy Retina - The retina acts like the film in a camera to: capture images transform the images into electrical signals send the signals to the brain Choroid - Cooling radiator for the retina Eye Damage by Wavelength UV-C = 100 to 280 nm (corneal hazard) UV-B = 280 to 315 nm (corneal/lens hazard) UV-A = 315 to 400 nm (corneal/lens hazard) Visible = 400 to 780 nm (retinal hazard) IR-A = 780 to 1400 nm (retinal hazard) IR-B = 1400 to 3000 nm (corneal hazard) IR-C = 3000 nm to 1 mm (corneal hazard) UV-A Wavelength: 315nm to 400nm Eye Effects: Photokeratitis, possible photochemical UV cataracts, retinal lesions Skin Effects: Pigment darkening, photosensitive reactions, skin burns

9 Visible Light Wavelengths: 400nm to 780nm Eye Effects: photochemical and thermal retinal injury in continuous wave and pulsed lasers; retinal hemorrhaging (submicrosecond pulses), degraded color and night vision Skin Effects: pigment darkening, photosensitive reactions, skin burns IR-B Wavelengths: 1400nm to 3000 nanometers Eye Effects: Corneal burns, IR Cataracts possible Skin Effects: Skin Burns IR-A Wavelengths: 780nm to 1400 nm Eye Effects: IR Cataracts, aqueous flare (blood vessel dilation near the Iris), Retinal Burns, Retinal Hemorrhaging (submicrosecond pulses) Skin Effects: Skin Burns

10 OPTICAL DENSITY (OD): Refers to the ability of the filter material to reduce the intensity/power of the beam by factor of 10. O.D. 1 2 3 4 5 6 ATTENUATION: 10 100 1000 10,000 100,000 1,000,000 Optical Density How do I find out my OD? Manufacturer s guide Do the calculation yourself based on WL, Power in watts, or if pulsed, WL, power in joules, pulse length in seconds, and pulse repetition rate in hertz Call a laser eyewear manufacturer and give above information and we can calculate it for you

11 Laser Safety - Selecting the Correct Glasses The safety glasses you wear depend on the lasers you work with and your processes. Your glasses need to block the all the wavelengths in use The optical density (OD) of your glasses should block the maximum power in use, especially for invisible wavelengths. The OD and wavelength ranges must be printed on the glasses. VLT in Ca. Laser Safety Laser Safety - Reflections Specular Diffuse

12 Golden Rules of Laser Safety Do NOT look into a laser beam. Keep the room lights bright (if possible). Remove or cover all jewelry. If the red warning light is on - knock first, only go in with permission AND glasses. Create as small a Nominal Hazard Zone as possible to contain all possible stray beams Don t bend down below or work near beam height. Wear laser safety eyewear! Golden Rules of Medical Safety Must be an LSO assigned for administrative duties. Standard Operating Procedures must be in place (hazards evaluation generally done by laser manufacturer) Protective equipment (patient & operator), signs & NHZ Know your non-beam hazards. Fire Explosion Chemical Slips & Trips Electrical Shock Laser Safety - Ancillary Hazards

13 Special Considerations Laser Generated Airborne Contaminates, (LGAC) Exhaust ventilation for surgery near respiratory passages. Similar to electrocautery smoke, laser plume can contain fumes from bacterial and viral sources. Blood borne pathogens; utilize control measures necessary (gloves, masks) Biohazards: filters of smoke evacuators/wall suction Instruments with low reflectance in beam path. Accessory attachments; i.e. laparoscopes, endoscopes, remote controls, fibers, surgical probes shall be compatible with and provide prerequisite laser safety. Laser filters in operating microscopes. Special Considerations Cont. Endotracheal tube fires plastic, plastic adhesive tape, ointments, surgery prep solutions can catch fire. Shielding with wet substrates, use low combustion gas mixtures. Silicon laser resistant tubes. PVC tubes not used, either wrapped or unwrapped. Tube cuffs should be inflated with liquid and externally protected with wet pads. Keep open container of water available. Digestive tract gases (methane) concern. Non-combustible anesthetic agents, localized ventilation techniques. Use only wet or fire retardant materials in surgery (biogel wound protective materials) Inadvertent foot petal activation can cause fires, burns to patient. What s in it for them? The structures for fines!

14 Something Missing? What s Wrong Here? Hint: Look at the left lens... What s wrong with this picture?

15 CHOOSING LASER EYEWEAR: Wavelength of eyewear must correspond to wavelength of laser, marked on eyewear with O.D. must be sufficient to reduce beam below maximum permissible exposure (MPE). California OSHA special markings include VLT % Factor of time - If filter is exposed to laser radiation, how long will filter last. Damage Threshold data VLT (visible light transmission) as high as possible Comfortable eyewear FIT: adjustable FACTORS TO CONSIDER WHEN CHOOSING LASER EYEWEAR: Rx Availability. Peripheral vision. Anti-fog Capabilities, especially goggles Multi Wavelength operation, flip options. Laser inscribed markings (printed ones wash off when cleaned) UV inhibitors to prevent darkening Cost (What s the cost of an eye?) Polymer Eyewear Polymer Lenses/Frames Lightweight Available in multiple frame styles, adjustable Anti-fog coatings available on polymer VLT markings which meet State of California s requirements Styles that can fit over prescriptions available, or insert behind. Lifetime Frame Guarantee

16 Polymer Laser Eyewear Translucent, laser resistant goggle bodies. Passes UV & environmental stabilization tests. Lenses will not darken over time. Special Caution: CO2 and UV --Streetwear lenses don t all absorb these wavelengths! Polycarbonate vs. CR39 vs. Acetate. Lens thickness variable. Study @ N.Caroline University,50% of streetwear users had advanced hardening of lens of eye. Glass Laser Eyewear: Not as Impact resistant as polymer, but don t scratch as easily. Heavier weight, limited frames. Glass prescriptions available. Made of: Mineral glass. Dielectrically Coated mineral glass. Layered laminates of mineral glass. Rare Earth minerals. Flips in glass base, plastic flip-down, or plastic combo. Dielectrically Coated Eyewear Usually higher visible light transmission (VLT) than polymer or glass lenses= you see better Critical protection, highest irradiance factors=highest levels of protection Limited frame styles due to coating process

17 Patient Eye Care Options Gauze, cotton balls, tape & quarters Pros Cheap Cons Looks cheap to patient and doctor Metal Eye Shields, extra ocular and intraocular corneal shields Disposable Patient Shields Green Glasses for IPL Lightspeed for IPL Laser Glasses Don t seal well around eyes when lasing the face Metal Patient Eye Shields Spectrashields Pros Inexpensive price range Good Coverage Comfortable for patient CE/ANSI marked Long Lasting Cons Covers crows feet area Cleaning, attaching disposable pads I-Block II Pros Very Competitively priced, for quality reusable product. Fits just orbital area Comfort improved with rolled edges that don t dig in. CE/ANSI marked Long Lasting Cons Middle bar blocks nasal area Cleaning, autoclaving Disposable Patient Shields IPL-Aid Pros Great coverage, no leaks. Disposable, no cleaning, no autoclaving, no crosscontamination Allows free access to nose bridge and crows feet and temple areas. Easy to apply and remove, can reposition Greater comfort for patient, lightweight. No down time between patients for cleaning. Cons Cost of use vs. metal shields, (factor in cleaning costs, time of tech to clean metal) Laser-Aid Pros Great protection at O.D.>7 @190-11,000nm Quick and easy for the nurse/tech/doctor- no cleaning, no autoclaving, no cross-contamination. Allows access to nose and temple areas. Easy to put on and take off, can reposition. Very comfortable for the patient to wear. Latex free and hypoallergenic Cons Cost of use vs. metal shields (factor in cleaning costs, time of tech to clean metal)

18 Cleaner for the patient, no cross contamination No gaps (as eyewear can form when lying down) Tighter to the orbital area of the eye for close in work Patient Results IPL Intense Pulse Light IPL Aid for the patient blocks the light. The adhesive makes it easy to reposition and remove. 50 pair to box; disposable, easy peel, hypoallergenic eye shields for shielding IPL light only. Fits and conforms to contour of eye allowing access to nose bridge, temples and areas near the eye. Non-sterile. p/n 31-9300 IPL Glasses reduce side effects associated with IPL flashes. Low light transmittance, in light shade green and dark shade green. 31-9623 green; 31-9624 dark green IPL Glasses Try the new XC in the light (31-80133) or dark (31-80134) shaded lenses for IPL List price is $49 ea Lightweight, wrap-around with adjustable temple lengths and fingers nosepiece for maximum comfort. Prescription insert available Other frame styles available in this lens.

19 IPL Intense Pulse Light Model: 31-90900 Glendale has taken Liquid Crystal technology from the aerospace and computer world and adapted it for use in safety eyewear. Work in daylight, but protected the whole time Light SPEED filter reacts in less than a millisecond to protect eyes in Intense Pulse Light (IPL) environments Glare reduction factor 2 to 9, with permanent UV and IR protection Eliminates the danger of accidents and loss of productivity associated with workers taking their eyewear on and off during procedures Saves time in lifting darker glasses to see and repositioning IPL. Minimizes headaches and other adverse effects associated with IPL glare as it alleviates the constant blinking. Fits comfortably over prescription eyewear Battery lasts for over a year. Part # 31-8300 Laser-Aid Disposable A lightweight, disposable, patient eye shield for use with virtually all lasers, from 190-11,000nm. Protection level is OD>7. Latex free & Hypoallergenic Allows access to bridge, brow and temples. Easy to apply & Comfortable to wear, fits most orbital sizes. 24 pair to a container. About $3 a client. CE approved. Product is Patented! I-Block II Patient Shield For use with laser or IPL applications, reusable, autoclavable stainless steel. CE approved. Adjustable strap, moveable nosepiece. Straps slip on/off easily. Rolled edges for patient comfort. Part #31-7410

20 Spectrashield, Spectraview Spectrashield is opaque, Spectraview has laser lenses to allow patient to see. Adjustable nosepiece and safety strap. Spectrashields protects against all medical lasers. Spectraview window made from poly or glass. CE certified. Microderm Abrasion DermAid Box of 100 (50 procedures) disposable, easy peel, hypoallergenic eye shields for microdermabrasion or physical barrier for masks only. Easy to position, reposition. Fits and conforms to contour of eye allowing access to nose bridge, temples and areas near the eye. Nonsterile. p/n 31-7300. LED-Aid LED-Aid Disposable LED Eye Shields (50 pair/box) Model #: 31-8400 Safe for use with LED's, low-powered lasers (<1 watt), IPL and microdermabrasion devices Protection level: (OD 4@190-10,600nm) Latex-free and hypoallergenic Allows access to bridge, brow and temples Easy to apply and comfortable to wear Designed to protect most orbital sizes

21 Windows Windows are available in different wavelength ranges, from 200 to 10,600nm Windows come in acrylic and glass DVO Acrylic windows sizes 2 feet x 3 feet, 0.125 inches thick DVO windows can be easily doubled to produce higher O.D. s Glass Windows are 100mm x 200mm, approximately 5-7mm thick Laser Curtains/ Barriers Ideal for when a physical barrier between the laser and surrounding offices or proximate work spaces is required. Constructed of rugged, high quality fiberglass impregnated fabric. Strengths to withstand from 2 W/cm2 to 300 W/cm2 from typical lasers In ceiling mounted, freestanding floor screens, magnetic window covers, Velcro window covers, and snap window covers GLENDALE LIFETIME FRAME GUARANTEE Glendale will guarantee lifetime frame replacement for any qualifying eyewear model when it breaks during the course of normal use, regardless of age. This guarantee applies to the following Glendale products: uvex LSK spectacle uvex LOTG spectacle uvex LPG goggle uvex LS6 goggle uvex L2 spectacle uvex LS3 spectacle uvex LS5 spectacle uvex LS9 spectacle Glendale LGF Full View Glendale LGM Millennia Glendale 70 Flexseal Glendale Encore 20,21 Glendale 01 Horizon Flip Glendale XC The frame of these uvex eyewear products will be replaced free of charge when received at our factory from the consumer. Postage and insurance are the responsibility of the consumer. If the particular product should be discontinued by uvex, then Glendale will replace the frame with a frame of comparable or greater value. 800-500-4739 phone 401-233-0293 fax

22 Certifications LSO course CMLSO certification, importance increasing, available since April 2004. Stay on top of changes and maintain competency in the industry of this growing sector. Gain a competitive edge in the work force today. 1. Candidate must demonstrates educational prerequisites and certain level of work experience, and knowledge in the area. 2. pass examination. Contact BLS@lasersafety.org The End Thank you for your attention. Contact phone is 925-485 485-0126

ILSC 2007 Laser Safety Practical Applications Seminar Evaluation Session #3: Medical Laser Safety - From the Operating Room to the Day Spa Course Instructor: Cathi Scogin Please rate the following: (circle) Very Course Excellent Good Good Fair Poor Overall Course 5 4 3 2 1 Course Instructor 5 4 3 2 1 Presentation of material 5 4 3 2 1 Organization of material 5 4 3 2 1 Course well paced 5 4 3 2 1 Would you recommend this course to others in your profession? yes no What was the strongest feature of the course? What was not covered that you felt should have been covered (if anything)? What would you like to hear more about next time? What was covered that left an impression/impact on you? Suggestions & Comments (for this course or courses you would like in the future): Name: (optional) Please Use Reverse Side for Additional Comments. Please return evaluation form to the Registration Desk by Wednesday afternoon or fax 407.380.5588 to LIA upon your return home. THANK YOU!