OSHA & Worker Safety

Laser Beam Safety Scheme

Why your health care organization needs to implement an effective
medical laser safety program

I
n just a few short decades, lasers have
evolved from the stuff of science How Class 4 Lasers Can
fiction to a trenchant tool of choice Harm Humans
commonly used today in science and
Class 4 is considered the most haz-
medicine. ardous laser class because it poses
But whether the setting is a hospital, more potential hazards to humans,
an outpatient clinic, or a laboratory, including:
lasers that aren’t properly maintained, • Putting eyes and skin at risk from
the direct beam
monitored, and operated can lead to se-
• Creating a diffuse reflection threat
rious injury—including corneal damage, Safety signage warning occupants of the (in which the beam is reflected off
skin burns, and patient airway fires—and dangers of medical lasers used on site a surface and scatters at many
even death to patients and staff alike. In should be posted and highly visible. angles) or fire danger
fact, the ECRI Institute reports that an • Generating unsafe levels of plasma
radiation (which is normally safe in
estimated 550 to 650 surgical fires occur tive tools than ever before to reduce laser some circumstances)
in the United States each year, many dangers. The bad news is that too many • Producing laser-generated airborne
of them involving lasers as an ignition organizations have not implemented contaminants that can spread
source.1 a proper medical laser safety program, viruses, bio-aerosols, gaseous tox-
ic compounds, dead and live cellu-
Approximately 12 laser systems, rated which is essential to minimize risks, lar material, particulates, and metal
as either Class 3B or 4, are found in ev- safeguard staff and patients, and reduce fumes, producing upper respiratory
eryday medical use.2 Although a Class 3B liability. tract irritations, vision problems,
laser system is typically not a fire hazard and other serious side effects2
or diffuse reflection threat (wherein the False sense of security
laser is reflected off a surface and scat- Medical laser safety programs are par-
tered at many angles rather than at just ticularly lacking in health care organiza- ANSI Z136.1–2014, “Safe Use of Lasers”
one angle), it can be hazardous whenever tions that don’t own their own lasers or (http://www.lia.org/store/ANSI/106)—
the laser is viewed directly or specularly don’t frequently perform laser-assisted one of several laser safety standards for
(as a mirrored reflection off a surface).2 procedures, according to Gus Anibarro, users in the United States developed
However, a Class 4 laser system, primar- education director with the Laser Insti- by the American National Standards
ily used in surgery as well as procedures tute of America (LIA), Orlando, Florida. Institute’s (ANSI’s) Accredited Standards
within many different specialties—in- In many cases, these organizations rent Committee and its publisher, the LIA.
cluding ophthalmology, urology, der- their lasers from third-party vendors and Furthermore, per standard ANSI
matology, otolaryngology and cardiolo- incorrectly assume that the laser rental Z136.3–2011, “Safe Use of Lasers in
gy—carries extra risk because Class 4 is company is responsible for laser safety in Health Care” (http://www.lia.org/store/
considered the most hazardous laser class the operating room or treatment area— ANSI/113), it is the employer’s duty to
and, therefore, has the most safety con- leading to a false sense of security. provide a laser safety officer (LSO) and
trol measures (see “How Class 4 Lasers “On the contrary, it is the employer’s laser safety program consisting of poli-
Can Harm Humans,” right). fundamental responsibility to ensure cies, procedures, and training to
The good news is that health care the safe use of lasers owned by and/or ensure that personnel are responsible
organizations are armed with more operated in facilities under its control,” laser users. “It’s vitally important for
knowledge, safety standards, and protec- says Anibarro, citing the revised standard (continued on page 8)

Page 7 Copyright 2015 The Joint Commission

Environment of Care News, February 2015, Volume 18, Issue 2
Laser Beam Safety Scheme
(continued from page 7)
Ten Steps to Laser Safety
health care organizations to institute a
medical laser safety program because The Laser Institute of America (LIA), Orlando, Florida, recommends the following 10
they have an obligation to protect their steps for starting a medical laser safety program:
patients,” says Anibarro. “Furthermore, Appoint a laser safety officer (LSO) and define this person’s roles and
1. 
under the Occupational Safety and responsibilities. This person is typically given the authority and responsibility to
Health Act, employers are responsible for implement, monitor, and enforce the program. Often, health care organizations
providing a safe and healthy workplace. choose a clinical engineer, radiation safety officer, operating room nurse, or
surgical technician to serve as the LSO because that person has previous
When investigating an unsafe workplace
experience operating, maintaining, or calibrating one or more laser systems
claim, OSHA [Occupational Safety and within the facility. (An LSO is required for Class 3B and 4 laser systems if a
Health Administration] may also check company decides to voluntarily comply with ANSI standards. Also, some US
to see if the facility was properly follow- states require that an organization identify its LSO.)
ing ANSI laser safety standards. Plus, the Train the LSO properly by enrolling this person in a course taught by a trusted
2. 
hospital is at greater risk of litigation and organization (such as LIA).
malpractice when it lacks a laser safety Draft a laser safety policy statement and establish the details of your
3. 
program.” organization’s laser safety program.
To help run such a program, many 4. C
 onduct an inventory of all Class 3B and Class 4 lasers. Find these most
health care organizations designate a staff hazardous types of lasers throughout the facility.
member to serve as an LSO. An LSO is 5. D
 istinguish which lasers are current on their preventive maintenance and
needed for Class 3B or 4 laser systems if which lasers are compliant with the Food and Drug Administration’s Center for
Devices and Radiological Health (CDRH) federal requirements (see
a company decides to voluntarily comply http://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/Overview/).
with the ANSI standard. Yet only seven Contact the manufacturers of any lasers that are not CDRH compliant.
states—Arizona, Florida, Georgia, 6. C
 omplete a laser hazard assessment for each operating room, carefully
Illinois, Massachusetts, New York, and following ANSI Z136.3.
Texas—currently require health care Examine, document, and control non-beam hazards, including laser-
7. 
facilities utilizing a Class 3B or 4 laser generated air contaminants caused by laser plume.
system to have an assigned LSO who Write standard operating and maintenance procedures for all laser systems
8. 
is properly trained, Anibarro says. on your inventory and implement measures for the control of beam and non-
Nevertheless, he recommends it for beam hazards.
every health care organization because Authorize laser personnel and employ training appropriate for the degree of
9. 
the facility could be cited by OSHA if it hazard.
doesn’t have an LSO in place. 10. Audit the program to ensure that it is effective and the controls and standard
In addition, Joint Commission– operating procedures for the hazards are actively keeping people safe.
accredited hospitals are expected to
comply with Environment of Care (EC)
Standard EC.02.02.01, which states “the exposure. Top management has to be in- simply not acceptable.”
hospital manages risks related to hazard- vested in the program and its goals for it The LIA recommends 10 steps for
ous materials and waste,” and its Element to work properly. starting a medical laser safety program
of Performance 7, which states “the “To ensure success, everyone has (see “Ten Steps to Laser Safety,” above.)
hospital minimizes risks associated with to be on the same page in terms of how
selecting and using hazardous energy safety standards are followed, precautions Understanding safety
sources.” are taken, staff are educated on the issue, standards
and systems and protocol are monitored When executing a medical laser safety
Ten steps to laser safety and evaluated,” says Anibarro. “An program, health care organizations will
Instituting an effective medical laser effective program requires collective want to abide by and stay up to date with
safety program requires a strong com- effort and consistent vigilance, but the latest industry standards, especially
mitment of resources and support from when you consider how vulnerable ANSI Z136.3–2011. Compliance with
health care administrators who are deter- human beings can be to these powerful this standard is on a voluntary basis for
mined to decrease laser risks and shield lasers, the time and work involved is well hospitals and other health care organiza-
employees and patients from harmful worth it, and an unsafe environment is tions; however, if an organization chooses

Page 8 Copyright 2015 The Joint Commission

Environment of Care News, February 2015, Volume 18, Issue 2
 Laser Appraisers is AORN’s Perioperative Standards and
Recommended Practices for Inpatient
Check out these helpful links for more tips and information on laser safety:
and Ambulatory Settings (http://www.
aornstandards.org), which includes prac-
• Laser Safety Information Bulletin (Laser Institute of America and OSHA): tice definitions and recommendations on
http://content.yudu.com/Library/A2wzks/LaserSafetyInformati/resources/index.
htm?referrerUrl=https%3A%2F%2F2.zoppoz.workers.dev%3A443%2Fhttp%2Ffree.yudu.com%2Fitem%2Fdetails%2F1993747
patient and worker safety. For additional
%2FLaser-Safety-Information-Bulletin resources, see “Laser Appraisers,” left. EC
• Laser effects on the human eye (Laser Institute of America and OSHA):
https://de356l4tocdyu.cloudfront.net/pdf/OSHAEyeFactSheet.pdf References
1. ECRI Institute. Preventing surgical fires: Im-
• Use of medical lasers (OSHA): http://www.osha.gov/SLTC/etools/hospital/surgical/ portant new recommendations released. News
lasers.html release, Oct 22, 2009. Accessed Dec 31, 2014.
http://www.prnewswire.com/news
• Laser hazards (OSHA): https://www.osha.gov/SLTC/laserhazards/index.html -releases/preventing-surgical-fires-important
-new-recommendations-released-65589412.
• Optical radiation: Laser protection (OSHA): http://www.osha.gov/SLTC/etools/ html.
eyeandface/ppe/laser_safety.html#Selection 2. US Department of Labor, Occupational Safety
and Health Administration. Surgical suite:
Use of medical lasers. Accessed Dec 30, 2014.
https://www.osha.gov/SLTC/etools/hospital/
to comply with this standard, then there update the document, making changes surgical/lasers.html.
is an expectation to implement what is to reflect any safety issues that have been
required for Class 3B and 4 lasers. “One identified since the last revision. Key This article was developed through the
of these requirements is that an organi- alterations made during the last revision cooperative efforts of the OSHA/Joint
zation must appoint a laser safety officer process in 2011 included eliminating the Commission Resources Alliance.
if it has Class 3B and 4 lasers or laser sys- term laser assistant, more clearly defining
tems,” says Anibarro. the terms laser operator and laser user, and
Like all other ANSI safety standards, relaxing the requirement to wear laser
ANSI Z136.3 undergoes a revision pro- safety glasses when using a laser device
cess every five to seven years. As part of with a properly shielded/armored fiber.
that process, the subcommittee members Another set of suggested guidelines

Page 9 Copyright 2015 The Joint Commission

Environment of Care News, February 2015, Volume 18, Issue 2