AS/NZS 4173:2018
Safe use of lasers and intense light sources in health care
Specifies requirements for the safe use of lasers and laser systems as well as intense light sources (ILS) in the treatment of humans for diagnostic, cosmetic, therapeutic, medical and dental uses in health care facilities, including hospitals, private medical facilities and dental practices, and the cosmetic industry. The standard explains the procedural and administrative controls necessary for the safety of patients, health care staff, maintenance personnel, and others who may be in the vicinity of the treatment room and in need of protection against inadvertent exposure. Engineering controls are an important part of laser safety and form part of the laser equipment or the installation. These are briefly described to provide an understanding of the general principles of protection. Detailed specification of laser equipment, installation and engineering controls are not included in this standard, such requirements being separately specified in AS IEC 60601.2.22.
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AS/NZS 4173:2018 SAFE USE OF LASERS AND INTENSE LIGHT SOURCES IN HEALTH CARE
PREFACE
CONTENTS
FOREWORD
SECTION 1 SCOPE AND GENERAL
1.1 SCOPE
1.2 APPLICATION
1.3 REFERENCED DOCUMENTS
1.4 DEFINITIONS
1.4.1 Absorption
1.4.2 Accessible emission limit (AEL) (lasers only)
1.4.3 Accessible radiation
1.4.4 Administrative control
1.4.5 Aiming beam (lasers only)
1.4.6 Aperture
1.4.7 Articulated arm delivery system (lasers only)
1.4.8 Attenuate
1.4.9 Average power
1.4.10 Aversion response
1.4.11 Beam diameter or beam width (lasers only)
1.4.12 Class of laser (lasers only)
1.4.13 Client
1.4.14 Coherent (lasers only)
1.4.15 Collimated beam (lasers only)
1.4.16 Competent person
1.4.17 Continuous wave (CW) (lasers only)
1.4.18 Convergence (lasers only)
1.4.19 Delivery system
1.4.20 Diffuse reflection
1.4.21 Distal
1.4.22 Divergence
1.4.23 Electromagnetic radiation
1.4.24 Embedded laser product (lasers only)
1.4.25 Energy
1.4.26 Energy density
1.4.27 Engineering controls
1.4.28 Exposure duration
1.4.29 Eye protection
1.4.30 Eye safe (lasers only)
1.4.31 Fibre optic delivery system (lasers only)
1.4.32 Focal length
1.4.33 Focal point
1.4.34 Human access (lasers only)
1.4.35 Intense light source (ILS)
1.4.36 Intense pulsed light (IPL)
1.4.37 Irradiance
1.4.38 Laser
1.4.39 Laser accident (lasers only)
1.4.40 Laser classification (lasers only)
1.4.41 Laser checklist (lasers only)
1.4.42 Laser controlled area (lasers only)
1.4.43 Laser delivery system (lasers only)
1.4.44 Laser emission indicator (lasers only)
1.4.45 Laser hazard area (lasers only)
1.4.46 Laser incident (lasers only)
1.4.47 Laser or ILS operator
1.4.48 Laser or ILS training
1.4.49 Laser or ILS user
1.4.50 Laser safety committee (LSC) (lasers only)
1.4.51 Laser Safety Officer (LSO) (lasers only)
1.4.52 Local exhaust ventilator (LEV)
1.4.53 Maintenance
1.4.54 Maximum permissible exposure (MPE) (lasers only)
1.4.55 May
1.4.56 Medical laser product (lasers only)
1.4.57 Monochromatic
1.4.58 Nominal ocular hazard area (NOHA) (lasers only)
1.4.59 Nominal ocular hazard distance (NOHD) (lasers only)
1.4.60 Ocular hazard distance (OHD) (ILS only)
1.4.61 Operation
1.4.62 Optical density
1.4.63 Patient
1.4.64 Peak power
1.4.65 Photobiomodulation
1.4.66 Plume
1.4.67 Power (P)
1.4.68 Power density
1.4.69 Proximal
1.4.70 Pulse mode (lasers only)
1.4.71 Q-switched laser (lasers only)
1.4.72 Radiant flux (radiant power)
1.4.73 Radiant energy Q
1.4.74 Radiant exposure H
1.4.75 Radiant power
1.4.76 Refraction
1.4.77 Retinal hazard (lasers only)
1.4.78 Risk Group (ILS only)
1.4.79 Scatter
1.4.80 Service
1.4.81 Shall
1.4.82 Should
1.4.83 Shutter (lasers only)
1.4.84 Specular reflection
1.4.85 Thermal relaxation time
1.4.86 Transmission
1.4.87 Ultraviolet radiation
1.4.88 Ultra low penetration air filter (ULPA)
1.4.89 Visible radiation
1.4.90 Working beam (lasers only)
SECTION 2 ADMINISTRATION FOR LASERS AND ILS
2.1 LASERS
2.1.1 Safety
2.1.2 Administration
2.1.3 Training
2.1.4 Medical credentialing
2.1.5 Laser operator certification
2.1.6 Standard operating procedures and checklists
2.1.7 Laser incidents
2.1.8 Incident reporting
2.1.9 Ophthalmic examinations
2.1.10 Skin examinations
2.1.11 Laser safety audits
2.2 ILS
2.2.1 General
2.2.2 Guidelines
2.2.3 Equipment malfunction and personnel injury
SECTION 3 INSPECTION, TESTING AND PREVENTIVE MAINTENANCE
3.1 GENERAL
3.2 ACCEPTANCE INSPECTION AND TESTING
3.3 QUALITY ASSURANCE (QA) TESTING OF EQUIPMENT PARTS
3.3.1 General
3.3.2 Cables
3.3.3 Emergency stop switches
3.3.4 Interlocks
3.3.5 Emission indicators
3.3.6 Beam power calibration
3.3.7 Articulated arm (lasers only)
3.3.8 Beam coincidence (lasers only)
3.3.9 Optical fibres (lasers only)
3.3.10 Aiming beam (lasers only)
3.3.11 Specialized accessories (lasers only)
3.3.12 Protective eyewear
3.3.13 IPL filters (IPL only)
3.4 PREVENTIVE MAINTENANCE
3.4.1 General
3.4.2 Cleaning and disinfection
3.4.3 Preventive maintenance check list
SECTION 4 SAFE PRACTICES
4.1 GENERAL
4.2 ESSENTIAL SAFETY REQUIREMENTS
4.3 OPERATIONAL PRACTICES
4.4 REMOVAL OF AIRBORNE CONTAMINANTS
4.4.1 General
4.4.2 Operator and patient protection
4.5 REDUCTION OF EXPLOSIVE HAZARD
4.6 PLUME AND OTHER NOXIOUS MATERIALS
4.6.1 General
4.6.2 Dye lasers
4.7 USER PRACTICES DURING SPECIALIST CLINICAL APPLICATIONS
4.8 EYE PROTECTION-LASERS
4.8.1 General
4.8.2 Eye protection with endoscopes
4.8.3 Factors in determining appropriate eyewear
4.9 EYE PROTECTION-ILS
4.10 ADDITIONAL PERSONAL PROTECTION-LASERS ONLY
4.11 AIMING BEAMS AND TARGET INDICATORS-LASERS ONLY
4.12 FIRE PROTECTION-LASERS ONLY
4.13 OPTICAL FIBRE SYSTEMS-LASERS ONLY
4.14 LASER ENVIRONMENT-LASERS ONLY
4.15 INSTALLATION REQUIREMENTS FOR CLASS 3B AND CLASS 4 MEDICAL LASERS
4.16 ILS ENVIRONMENT
APPENDIX A - LASERS, ILS AND THEIR PROPERTIES
A1 GENERAL
A2 LIGHT
A3 LASERS
A3.1 Introduction
A3.2 What is a laser?
A3.3 Modes of operation
A3.4 Properties of lasers
A3.5 Parameters used to characterize laser output
A4 IPLs
A4.1 General
A4.2 Construction
A4.3 Filtration
A4.4 Applicators
A4.5 Pulse shape
A4.6 The IPL beam
A4.7 IPL light absorption
A4.8 Safety considerations
A5 OTHER ILS
APPENDIX B - SAFETY ISSUES IN LASER APPLICATIONS
B1 SCOPE OF APPENDIX
B2 USE OF OPTICAL FIBRES
B2.1 Hazard summary
B2.2 Precautions
B3 USE OF LASERS WITH FLEXIBLE ENDOSCOPES
B3.1 Hazard summary
B3.2 Precautions
B4 USE OF LASERS WITH RIGID ENDOSCOPES, MICROSCOPES AND COLPOSCOPES
B4.1 Hazard summary
B4.2 Precautions
B5 USE OF LASERS WITH FREE HAND MANIPULATION CAPABILITY
B5.1 Hazard summary
B5.2 Precautions
B6 USE OF LASERS IN OPHTHALMOLOGY
B6.1 Hazard summary
B6.2 Precautions
B7 USE OF LASERS IN CONJUNCTION WITH ANAESTHESIA
B7.1 Hazard summary
B7.2 Precautions
B8 USE OF CLASS 3B AND CLASS 4 LASERS ON THE SKIN
B8.1 Hazard summary
B8.2 Precautions
B9 USE OF CLASS 3B AND CLASS 4 LASERS IN DENTISTRY
B9.1 Hazard summary
B9.2 Precautions
B10 PHOTOBIOMODULATION (PBM)
B10.1 Hazard summary
B10.2 Precautions
APPENDIX C - LASER DELIVERY SYSTEMS
C1 GENERAL
C2 DIRECT DELIVERY
C3 ARTICULATED ARM
C3.1 General
C3.2 Limitations of an articulated arm
C4 HOLLOW FLEXIBLE WAVEGUIDE
C5 FIBRE OPTICS
C5.1 General
C5.2 Limitations of fibre delivery systems
C5.3 Risk to endoscope
C6 HANDPIECES AND APPLICATORS
C6.1 Applicators with focusing lenses
C6.2 Limitations of lens systems
C6.3 Micromanipulators
APPENDIX D - BIOLOGICAL EFFECTS
D1 LASER INTERACTIONS WITH TISSUE
D1.1 General
D1.2 Optical interactions
D2 THERMAL
D3 PHOTODISSOCIATION
D4 PHOTOACOUSTIC (ELECTROMECHANICAL, PHOTOMECHANICAL)
D5 PHOTOCHEMICAL
D6 PHOTOBIOMODULATION (PBM)
APPENDIX E - LASER HAZARDS
E1 INTRODUCTION
E2 CLASSIFICATION OF LASER PRODUCTS BY HAZARD
E2.1 General
E3 ORGANS AT RISK
E3.1 General
E3.2 The eyes
E3.3 The skin
E4 PULSED LASERS
E5 OPTICAL FIBRE BREAKAGES
E6 AIRBORNE CONTAMINANTS
E7 FUMES AND VAPOURS
E8 UNSHIELDED LASER FLASH LAMPS/OPTICAL CAVITY
E9 HEATED SURFACES OR INSTRUMENTS
E10 REFLECTIONS
APPENDIX F - ILS HAZARDS
F1 GENERAL
F2 CLASSIFICATION OF ILS DEVICES
F3 RISKS TO THE EYE
F3.1 Inadvertent eye exposure
F3.2 Treatment adjacent to the eye
F4 SKIN BURNS
F5 SCARS
F6 HYPER/HYPO-PIGMENTATION
F7 PURPURA
F8 UNRECOGNIZED MALIGNANCIES OR PREMALIGNANT CONDITIONS AT THE TREATMENT SITE
F9 DELICATE ANATOMY OR INAPPROPRIATE TREATMENT SITES
F10 DRUG-INDUCED PHOTOSENSITIVITY
F11 CONTRA-INDICATED CLIENT CONDITIONS
F12 PLUME
APPENDIX G - LASER AND ILS PRODUCT HAZARD CLASSES
G1 LASERS
G1.1 Laser classes
G1.2 Laser product labelling requirements
G2 LASER EQUIPMENT SAFETY FEATURES
G3 OPTICAL GUIDES
G4 CLASSIFICATION OF ILS PRODUCTS
APPENDIX H - DOCUMENTATION SAMPLES
H1 INTRODUCTION
H2 SAMPLE CHECK LISTS
H2.1 General
H2.2 Sample check list (S1)-pre-operative
H2.3 Sample check list (S2)-intraoperative
H2.4 Sample check list (S3)-post-operative
H2.5 Sample check list (S4)-laser safety audit tool
H2.6 Sample check list (S5)-skills validation
H3 LASER OPERATOR/USER SKILLS CHECKLIST-GUIDANCE
H3.1 General
H3.2 Equipment set up criteria
H3.3 Procedure competencies criteria
H3.4 Safety criteria
H3.5 Laser knowledge criteria
H3.6 Laser procedure log
H4 POLICIES AND PROCEDURES
H4.1 General
H4.2 Policies and procedures for laser use-controlled access
H4.3 Policies and procedures for laser use-flammability hazard and fire safety
H4.4 Policies and procedure for laser use-handling of fibre optic delivery systems
H4.5 Policies and procedures for laser use-laser generated airborne contaminants
H4.6 Policies and procedures for laser use-ocular safety
H4.7 Policies and procedures for laser use-test firing of CO2 lasers
APPENDIX I - TRAINING PROGRAMS
I1 SCOPE
I2 LASERS
I2.1 Clinicians/users
I2.2 Clinical support staff
I2.3 Health care facility Laser Safety Officer (LSO)
I2.4 Laser equipment service staff
I2.5 Suggested subject matter for laser safety training programs
I3 Education and training-ILS
APPENDIX J - WINDOW SHIELDING
J1 LASERS
J1.1 General
J1.2 Laser wavelength
J1.3 Irradiance or radiant exposure
J1.4 Fire/heat resistance
J1.5 Attachment/detachment
J2 ILS
APPENDIX K - PROTECTIVE EYEWEAR
K1 GENERAL
K2 LASERS
K2.1 Standard
K2.2 Type of laser
K2.3 Wavelength
K2.4 Scale number
K2.5 Other markings
K2.6 Combination of markings
K2.7 OD/wavelength system
K2.8 Wearing protective eyewear
K2.9 Visible light transmission (VLT)
K3 IPL and other ILS eyewear
K3.1 Standard
K3.2 Wavelength range
K3.3 Protection level (transmittance)
K3.4 Active protective (auto darkening) eyewear (IPL)
K3.5 Wearing protective eyewear
K3.6 Visible light transmission (VLT)
K3.7 Patient/client protection
APPENDIX L - RISK ASSESSMENT
L1 GENERAL
L2 WHAT IS RISK ASSESSMENT?
L3 HOW IS A RISK ASSESSMENT PERFORMED?
L4 SOURCES OF INFORMATION
APPENDIX M - LASER SAFETY COMMITTEE
M1 LASER SAFETY COMMITTEE
M2 LASER SAFETY OFFICER (LSO)
M3 HEALTH CARE FACILITY AND EQUIPMENT SAFETY AUDITS (CLASS 3B AND CLASS 4)
APPENDIX N - ADVISORY/REGULATORY AUTHORITIES
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References
Approval and test specification - Medical electrical equipment - General requirements for safety - Collateral Standard - Safety requirements for medical electrical systems
Medical electrical equipment - Part 1.2: General requirements for safety - Collateral Standard: Electromagnetic compatibility - Requirements and tests
Approval and test specification - Medical electrical equipment - Part 1.4: General requirements for safety - Collateral Standard - Programmable electrical medical systems
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Gamma beam therapy equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Anaesthetic systems
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Capacitor discharge X-ray generators
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Oxygen concentrators for individual patient use
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Dento-maxillofacial X-ray equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Infant apnoea monitors for domestic use
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Diagnostic and therapeutic laser equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Transcutaneous partial pressure monitoring equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Infusion pumps and controllers
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Electroencephalographs
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Automatic cycling non-invasive blood pressure monitoring equipment
Medical electrical equipment - Part 2.33: Particular requirements for safety - Magnetic resonance equipment for medical diagnosis
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Direct blood-pressure monitoring equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Blankets, pads and mattresses intended for heating in medical use
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Extracorporeally induced lithotripsy
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Peritoneal dialysis equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Cardiac defibrillators
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Electromyographs and evoked response equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Surgical luminaires and luminaires for diagnosis
Medical electrical equipment - Part 2.44: Particular requirements for safety - X-ray equipment for computed tomography
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Operating tables
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Ultrasonic physiotherapy equipment
Approval and test specification - Medical electrical equipment - Particular requirements for safety - Microwave therapy equipment
Reprocessing of reusable medical devices in health service organizations
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AS/NZS 4173:2018 SAFE USE OF LASERS AND INTENSE LIGHT SOURCES IN HEALTH CARE
PREFACE
CONTENTS
FOREWORD
SECTION 1 SCOPE AND GENERAL
1.1 SCOPE
1.2 APPLICATION
1.3 REFERENCED DOCUMENTS
1.4 DEFINITIONS
1.4.1 Absorption
1.4.2 Accessible emission limit (AEL) (lasers only)
1.4.3 Accessible radiation
1.4.4 Administrative control
1.4.5 Aiming beam (lasers only)
1.4.6 Aperture
1.4.7 Articulated arm delivery system (lasers only)
1.4.8 Attenuate
1.4.9 Average power
1.4.10 Aversion response
1.4.11 Beam diameter or beam width (lasers only)
1.4.12 Class of laser (lasers only)
1.4.13 Client
1.4.14 Coherent (lasers only)
1.4.15 Collimated beam (lasers only)
1.4.16 Competent person
1.4.17 Continuous wave (CW) (lasers only)
1.4.18 Convergence (lasers only)
1.4.19 Delivery system
1.4.20 Diffuse reflection
1.4.21 Distal
1.4.22 Divergence
1.4.23 Electromagnetic radiation
1.4.24 Embedded laser product (lasers only)
1.4.25 Energy
1.4.26 Energy density
1.4.27 Engineering controls
1.4.28 Exposure duration
1.4.29 Eye protection
1.4.30 Eye safe (lasers only)
1.4.31 Fibre optic delivery system (lasers only)
1.4.32 Focal length
1.4.33 Focal point
1.4.34 Human access (lasers only)
1.4.35 Intense light source (ILS)
1.4.36 Intense pulsed light (IPL)
1.4.37 Irradiance
1.4.38 Laser
1.4.39 Laser accident (lasers only)
1.4.40 Laser classification (lasers only)
1.4.41 Laser checklist (lasers only)
1.4.42 Laser controlled area (lasers only)
1.4.43 Laser delivery system (lasers only)
1.4.44 Laser emission indicator (lasers only)
1.4.45 Laser hazard area (lasers only)
1.4.46 Laser incident (lasers only)
1.4.47 Laser or ILS operator
1.4.48 Laser or ILS training
1.4.49 Laser or ILS user
1.4.50 Laser safety committee (LSC) (lasers only)
1.4.51 Laser Safety Officer (LSO) (lasers only)
1.4.52 Local exhaust ventilator (LEV)
1.4.53 Maintenance
1.4.54 Maximum permissible exposure (MPE) (lasers only)
1.4.55 May
1.4.56 Medical laser product (lasers only)
1.4.57 Monochromatic
1.4.58 Nominal ocular hazard area (NOHA) (lasers only)
1.4.59 Nominal ocular hazard distance (NOHD) (lasers only)
1.4.60 Ocular hazard distance (OHD) (ILS only)
1.4.61 Operation
1.4.62 Optical density
1.4.63 Patient
1.4.64 Peak power
1.4.65 Photobiomodulation
1.4.66 Plume
1.4.67 Power (P)
1.4.68 Power density
1.4.69 Proximal
1.4.70 Pulse mode (lasers only)
1.4.71 Q-switched laser (lasers only)
1.4.72 Radiant flux (radiant power)
1.4.73 Radiant energy Q
1.4.74 Radiant exposure H
1.4.75 Radiant power
1.4.76 Refraction
1.4.77 Retinal hazard (lasers only)
1.4.78 Risk Group (ILS only)
1.4.79 Scatter
1.4.80 Service
1.4.81 Shall
1.4.82 Should
1.4.83 Shutter (lasers only)
1.4.84 Specular reflection
1.4.85 Thermal relaxation time
1.4.86 Transmission
1.4.87 Ultraviolet radiation
1.4.88 Ultra low penetration air filter (ULPA)
1.4.89 Visible radiation
1.4.90 Working beam (lasers only)
SECTION 2 ADMINISTRATION FOR LASERS AND ILS
2.1 LASERS
2.1.1 Safety
2.1.2 Administration
2.1.3 Training
2.1.4 Medical credentialing
2.1.5 Laser operator certification
2.1.6 Standard operating procedures and checklists
2.1.7 Laser incidents
2.1.8 Incident reporting
2.1.9 Ophthalmic examinations
2.1.10 Skin examinations
2.1.11 Laser safety audits
2.2 ILS
2.2.1 General
2.2.2 Guidelines
2.2.3 Equipment malfunction and personnel injury
SECTION 3 INSPECTION, TESTING AND PREVENTIVE MAINTENANCE
3.1 GENERAL
3.2 ACCEPTANCE INSPECTION AND TESTING
3.3 QUALITY ASSURANCE (QA) TESTING OF EQUIPMENT PARTS
3.3.1 General
3.3.2 Cables
3.3.3 Emergency stop switches
3.3.4 Interlocks
3.3.5 Emission indicators
3.3.6 Beam power calibration
3.3.7 Articulated arm (lasers only)
3.3.8 Beam coincidence (lasers only)
3.3.9 Optical fibres (lasers only)
3.3.10 Aiming beam (lasers only)
3.3.11 Specialized accessories (lasers only)
3.3.12 Protective eyewear
3.3.13 IPL filters (IPL only)
3.4 PREVENTIVE MAINTENANCE
3.4.1 General
3.4.2 Cleaning and disinfection
3.4.3 Preventive maintenance check list
SECTION 4 SAFE PRACTICES
4.1 GENERAL
4.2 ESSENTIAL SAFETY REQUIREMENTS
4.3 OPERATIONAL PRACTICES
4.4 REMOVAL OF AIRBORNE CONTAMINANTS
4.4.1 General
4.4.2 Operator and patient protection
4.5 REDUCTION OF EXPLOSIVE HAZARD
4.6 PLUME AND OTHER NOXIOUS MATERIALS
4.6.1 General
4.6.2 Dye lasers
4.7 USER PRACTICES DURING SPECIALIST CLINICAL APPLICATIONS
4.8 EYE PROTECTION-LASERS
4.8.1 General
4.8.2 Eye protection with endoscopes
4.8.3 Factors in determining appropriate eyewear
4.9 EYE PROTECTION-ILS
4.10 ADDITIONAL PERSONAL PROTECTION-LASERS ONLY
4.11 AIMING BEAMS AND TARGET INDICATORS-LASERS ONLY
4.12 FIRE PROTECTION-LASERS ONLY
4.13 OPTICAL FIBRE SYSTEMS-LASERS ONLY
4.14 LASER ENVIRONMENT-LASERS ONLY
4.15 INSTALLATION REQUIREMENTS FOR CLASS 3B AND CLASS 4 MEDICAL LASERS
4.16 ILS ENVIRONMENT
APPENDIX A - LASERS, ILS AND THEIR PROPERTIES
A1 GENERAL
A2 LIGHT
A3 LASERS
A3.1 Introduction
A3.2 What is a laser?
A3.3 Modes of operation
A3.4 Properties of lasers
A3.5 Parameters used to characterize laser output
A4 IPLs
A4.1 General
A4.2 Construction
A4.3 Filtration
A4.4 Applicators
A4.5 Pulse shape
A4.6 The IPL beam
A4.7 IPL light absorption
A4.8 Safety considerations
A5 OTHER ILS
APPENDIX B - SAFETY ISSUES IN LASER APPLICATIONS
B1 SCOPE OF APPENDIX
B2 USE OF OPTICAL FIBRES
B2.1 Hazard summary
B2.2 Precautions
B3 USE OF LASERS WITH FLEXIBLE ENDOSCOPES
B3.1 Hazard summary
B3.2 Precautions
B4 USE OF LASERS WITH RIGID ENDOSCOPES, MICROSCOPES AND COLPOSCOPES
B4.1 Hazard summary
B4.2 Precautions
B5 USE OF LASERS WITH FREE HAND MANIPULATION CAPABILITY
B5.1 Hazard summary
B5.2 Precautions
B6 USE OF LASERS IN OPHTHALMOLOGY
B6.1 Hazard summary
B6.2 Precautions
B7 USE OF LASERS IN CONJUNCTION WITH ANAESTHESIA
B7.1 Hazard summary
B7.2 Precautions
B8 USE OF CLASS 3B AND CLASS 4 LASERS ON THE SKIN
B8.1 Hazard summary
B8.2 Precautions
B9 USE OF CLASS 3B AND CLASS 4 LASERS IN DENTISTRY
B9.1 Hazard summary
B9.2 Precautions
B10 PHOTOBIOMODULATION (PBM)
B10.1 Hazard summary
B10.2 Precautions
APPENDIX C - LASER DELIVERY SYSTEMS
C1 GENERAL
C2 DIRECT DELIVERY
C3 ARTICULATED ARM
C3.1 General
C3.2 Limitations of an articulated arm
C4 HOLLOW FLEXIBLE WAVEGUIDE
C5 FIBRE OPTICS
C5.1 General
C5.2 Limitations of fibre delivery systems
C5.3 Risk to endoscope
C6 HANDPIECES AND APPLICATORS
C6.1 Applicators with focusing lenses
C6.2 Limitations of lens systems
C6.3 Micromanipulators
APPENDIX D - BIOLOGICAL EFFECTS
D1 LASER INTERACTIONS WITH TISSUE
D1.1 General
D1.2 Optical interactions
D2 THERMAL
D3 PHOTODISSOCIATION
D4 PHOTOACOUSTIC (ELECTROMECHANICAL, PHOTOMECHANICAL)
D5 PHOTOCHEMICAL
D6 PHOTOBIOMODULATION (PBM)
APPENDIX E - LASER HAZARDS
E1 INTRODUCTION
E2 CLASSIFICATION OF LASER PRODUCTS BY HAZARD
E2.1 General
E3 ORGANS AT RISK
E3.1 General
E3.2 The eyes
E3.3 The skin
E4 PULSED LASERS
E5 OPTICAL FIBRE BREAKAGES
E6 AIRBORNE CONTAMINANTS
E7 FUMES AND VAPOURS
E8 UNSHIELDED LASER FLASH LAMPS/OPTICAL CAVITY
E9 HEATED SURFACES OR INSTRUMENTS
E10 REFLECTIONS
APPENDIX F - ILS HAZARDS
F1 GENERAL
F2 CLASSIFICATION OF ILS DEVICES
F3 RISKS TO THE EYE
F3.1 Inadvertent eye exposure
F3.2 Treatment adjacent to the eye
F4 SKIN BURNS
F5 SCARS
F6 HYPER/HYPO-PIGMENTATION
F7 PURPURA
F8 UNRECOGNIZED MALIGNANCIES OR PREMALIGNANT CONDITIONS AT THE TREATMENT SITE
F9 DELICATE ANATOMY OR INAPPROPRIATE TREATMENT SITES
F10 DRUG-INDUCED PHOTOSENSITIVITY
F11 CONTRA-INDICATED CLIENT CONDITIONS
F12 PLUME
APPENDIX G - LASER AND ILS PRODUCT HAZARD CLASSES
G1 LASERS
G1.1 Laser classes
G1.2 Laser product labelling requirements
G2 LASER EQUIPMENT SAFETY FEATURES
G3 OPTICAL GUIDES
G4 CLASSIFICATION OF ILS PRODUCTS
APPENDIX H - DOCUMENTATION SAMPLES
H1 INTRODUCTION
H2 SAMPLE CHECK LISTS
H2.1 General
H2.2 Sample check list (S1)-pre-operative
H2.3 Sample check list (S2)-intraoperative
H2.4 Sample check list (S3)-post-operative
H2.5 Sample check list (S4)-laser safety audit tool
H2.6 Sample check list (S5)-skills validation
H3 LASER OPERATOR/USER SKILLS CHECKLIST-GUIDANCE
H3.1 General
H3.2 Equipment set up criteria
H3.3 Procedure competencies criteria
H3.4 Safety criteria
H3.5 Laser knowledge criteria
H3.6 Laser procedure log
H4 POLICIES AND PROCEDURES
H4.1 General
H4.2 Policies and procedures for laser use-controlled access
H4.3 Policies and procedures for laser use-flammability hazard and fire safety
H4.4 Policies and procedure for laser use-handling of fibre optic delivery systems
H4.5 Policies and procedures for laser use-laser generated airborne contaminants
H4.6 Policies and procedures for laser use-ocular safety
H4.7 Policies and procedures for laser use-test firing of CO2 lasers
APPENDIX I - TRAINING PROGRAMS
I1 SCOPE
I2 LASERS
I2.1 Clinicians/users
I2.2 Clinical support staff
I2.3 Health care facility Laser Safety Officer (LSO)
I2.4 Laser equipment service staff
I2.5 Suggested subject matter for laser safety training programs
I3 Education and training-ILS
APPENDIX J - WINDOW SHIELDING
J1 LASERS
J1.1 General
J1.2 Laser wavelength
J1.3 Irradiance or radiant exposure
J1.4 Fire/heat resistance
J1.5 Attachment/detachment
J2 ILS
APPENDIX K - PROTECTIVE EYEWEAR
K1 GENERAL
K2 LASERS
K2.1 Standard
K2.2 Type of laser
K2.3 Wavelength
K2.4 Scale number
K2.5 Other markings
K2.6 Combination of markings
K2.7 OD/wavelength system
K2.8 Wearing protective eyewear
K2.9 Visible light transmission (VLT)
K3 IPL and other ILS eyewear
K3.1 Standard
K3.2 Wavelength range
K3.3 Protection level (transmittance)
K3.4 Active protective (auto darkening) eyewear (IPL)
K3.5 Wearing protective eyewear
K3.6 Visible light transmission (VLT)
K3.7 Patient/client protection
APPENDIX L - RISK ASSESSMENT
L1 GENERAL
L2 WHAT IS RISK ASSESSMENT?
L3 HOW IS A RISK ASSESSMENT PERFORMED?
L4 SOURCES OF INFORMATION
APPENDIX M - LASER SAFETY COMMITTEE
M1 LASER SAFETY COMMITTEE
M2 LASER SAFETY OFFICER (LSO)
M3 HEALTH CARE FACILITY AND EQUIPMENT SAFETY AUDITS (CLASS 3B AND CLASS 4)
APPENDIX N - ADVISORY/REGULATORY AUTHORITIES
AS/NZS 4173:2018
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