New Equipment, New Challenges: Managing a Laser Safety Program

Abstract

Q: Our hospital recently purchased a few CO2 lasers for use in various types of surgery. Since we only have a few lasers, do we need a Laser Safety Officer (LSO)? With or without that position, what are some common problems with CO2 type lasers?A: The quick answer is yes, you need an LSO. Lasers in healthcare facilities are governed by the American National Standards Institute (ANSI). Specifically, ANSI Z136.1-2000 addresses the laser safety program for healthcare facilities. The standard states, “An individual shall be designated the Laser Safety Officer (LSO) with the authority and responsibility to monitor and enforce the control of laser hazards and to effect the knowledgeable evaluation and control of laser hazards.” The LSO is responsible for education and enforcement of policies that relate to the safe use of lasers, and works collaboratively with many other departments in the hospital, including clinical engineering. If there is a laser-related incident, the LSO is responsible for controlling the investigation of the incident. It is a lot of responsibility but it is also rewarding. As with any program in order for it to be successful all employees involved must fully support the program and “buy in” to its policies. For more information, you can go to www.ansi.org.As for the second part of the question, there are some things that a facility should be aware of with a CO2 laser, which is one of several types that might be found in a hospital. The first and foremost is beam alignment. Most operating room (OR)/surgical CO2 lasers have an articulating arm, which attaches to a microscope or some similar device. This arm must be oriented in the correct direction (usually the arm has an arrow indicating the proper orientation) for correct beam alignment. Usually the person setting up the laser is aware of this but occasionally someone new will attempt to set up the laser and a biomed tech will get a call that “the beam is not firing correctly.” Always check the orientation of the articulating arm as your first step—it can save you a lot of time chasing a problem that was operator error and not device-related.Prior to each surgical case, the operator should test fire the laser onto a wet tongue blade. If the beam spot is in one place and the laser beam fires in another spot this will prompt staff to call saying, “the beam alignment is off.” Unfortunately, this usually cannot be adjusted in seconds prior to a case, so the surgery might be delayed.First, check the articulating arm and the main housing going into the laser for bends or buckles in the arm. One slight bump against a doorway can bend or buckle the arm and misalign the mirrors. This will usually require the purchase of a new arm. If the arm is not physically damaged, do an adjustment on the mirror inside the main turret. Often, transporting the laser will cause one of the mirrors to move and the beam to be misaligned. The technician should seek the service manual at this point to determine the location and adjustment procedure for the near and far mirrors.These are the two of the most common issues one will encounter with a CO2 laser. Most lasers are fairly resilient if cared for correctly. But like most equipment they do not tolerate being abused (inadvertently run into walls, hit on doorways, transported between facilities, etc.).