Minimum standard guidelines of care on requirements for setting up
Contents
1. e These guidelines do not supersede any local state or central government laws Facility e Laser treatment is an office procedure hence it does not require hospital set up However surgical laser procedures can be done in dermato surgical minor theater A procedure room in dermatologists clinic can very well be converted into a laser room 7 e Laser procedures are classified as surgical and 102 nonsurgical laser procedures e Laser procedures which cause minimal or no surface injury are performed under local anesthesia or without any anesthesia e Surgical laser procedures requiring extensive nerve block or general anesthesia with anticipated bleeding or anticipated larger raw skin surface injury need a dermato surgical theatre facility The laser room facility also called controlled area laser requires careful planning keeping in mind safety of both patient and operator and convenience of operating and optimum handling of costly equipments This includes planning for location dimension non reflective and laser opaque surfaces and lighting electrical requirements and air conditioning ventilation and smoke evacuation uninterrupted power supply operation table or chair operator s chair eye protection devices pre laser and post laser kits surgical instruments sterilization of devices asepsis and emergency management system These are described below in detail Physician qualification evidence level2. chlorpheniramine maleate adrenaline and atropine should be kept along with the emergency equipments An electrosurgical device or other means of hemostasis should be available when ablative treatments are planned An electrocautery or radiofrequency cautery is enough A source of airway maintenance should be available Mouth to mask resuscitation device or ambu bag and mask or a source of oxygen delivery up to 5 L min should be available Local anesthetic agents with and without epinephrine should be available Anesthesia The infiltration anesthesia is always administered by the physician Topical anesthesia may be administered by a nurse non physician laser operator Lignocaine sensitivity test and its documentation is always advisable Further details are available in IADVL guidelines for local anesthesia Topical Anaesthesia Most of the laser procedures are done under topical anaesthesia Cleaning disinfection and photography of treatment area is done prior to applying topical anaesthesia Fifty to 80 minutes is the time gap between application and start of procedure Thick layer and occlusion under self adhesive plaster is recommended for deeper penetration Records Case paper A clinical history is noted in the patient s record to identify significant medical problems allergies bleeding disorders and current medications Recording of data in computers is preferred if feasible Use of specialized dermatologica
3. its door and patient s table should be such that it should facilitate easy movement of patient machine trolley operator and assistant in case of routine procedures and in emergency Physician Qualification Any dermatologist with MD or diploma in dermatology can do laser procedures provided he she has acquired necessary skills by virtue of training observing a competent dermatologist Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures Electricity and uninterrupted power supply Laser equipments should be connected to stabilizer or UPS circuits only Preferably an on line UPS as recommended by the laser company should be installed Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator Sufficient power back up to complete the procedure if power is off midway is essential Air conditioning Laser machines should be operated in low ambient temperature with low humidity and dust free environment for longer life of machines Patient chair A dental cosmetic chair with adjustable task light is a suitable option for patient positioning The chair should have the option to tilt head down or syncope position to facilitate resuscitation of a patient in vaso vagal shock Maintenance Annual maintenance contract AMC is essential after warranty period is over and is e
4. dust free environment low ambient temperature and well grounded and uninterrupted power supply without voltage fluctuation e Machines must be covered during cleaning of laser room and when not in use e Regular service visits of service engineer should be scheduled as per manufacturer s recommendation e The Annual Maintenance contract AMC from supplier is essential after warranty period is over e AMC is also essential for insurance e Insurance Fire insurance is a minimum for all costly devices e Breakdown insurance is costly it has a very high premium hence to be done in very delicate machines and as per usage of machine Machines if handled by multiple operators or operated in multiple rooms should always be insured e In mobile laser units Insurance for mobility from one clinic to another or one city to another should be specifically obtained though this has high premium e While taking insurance it is essential that it is clearly specified which parts are covered for e g fiber optics laser modules etc It is important that these terms are included in the cover note and the final policy e Cooling devices Cooling is a mainstay in patient safety and getting better results External cooling devices like Zimmer contains compressor hence Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultr
5. 31 Laser room guidelines printandei Dbu3SZf KMa kAXAzNzbCQandsa Xandoi tr anslateandresnum 1andct resultandprev search 3Fq 3 Dvan 2BNorren 2BD 2B 2BNed 2BTijdschr 2BGene eskd 2B1998 253B142 1979 82 26h 1 3Den 26sa 3DG Accessed on 2009 Mar 11 Mainster MA Stuck BE Brown J Jr Assessment of alleged retinal laser injuries Arch Ophthalmol 2004 122 1210 1217 Tobin HA Lee DR Stewart G editors Designing the facility Ambulatory surgery and office procedures in head and neck surgery Orlando Fla Grune and Stratton 1986 p 303 14 jou rnal The manuscript system www journalonweb com allows the authors to check and verify the accuracy and style of references The tool checks the references with PubM ed as per a predefined style Authors are encouraged to use this facility before submitting articles to the e The style as well as bibliographic elements should be 100 accurate to help get the references verified from the system Even a single spelling error or addition of issue number month of publication will lead to an error when verifying the reference e Example of a correct style Sheahan P O leary G Lee G Fitzgibbon J Cystic cervical metastases Incidence and diagnosis using fine needle aspiration biopsy Otolaryngol Head Neck Surg 2002 127 294 8 e Only the references from journals indexed in PubM ed will be checked e Enter each reference in new line without a serial number e Add up to
6. B e Any qualified dermatologist DVD or MD may perform the procedure e To ensure successful cosmetic outcome the physician should have basic knowledge and training about laser physics and laser tissue interaction e The training may be obtained during post Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 Dhepe graduation if the centre for post graduation offers such training or later in dedicated workshops Proper hands on training should be obtained from equipment supplier s medical experts or from a dermatologist plastic surgeon experienced in performing the procedure e The physician should be familiar with early recognition prevention and treatment of post laser post procedure complications such as hyper or hypo pigmentation scarring burns etc Nonphysician operator qualification Many lasers are simple to use and a nurse or a nonphysician operator may be allowed to perform the laser after proper training These include nonsurgical or non ablative and semi ablative lasers However the nonphysician operator should perform only under supervision of the treating physician independent working of non dermatologist operators is not recommended It should also be understood that primary legal responsibility of result and complications of treatment performed by operator though trained lies with the treating physician only Laser procedure room evidence level B e The room and building desig
7. J Am Acad Dermatol Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Laser room guidelines 1999 41 484 95 Drake LA Ceilley RI Cornelison RL Dinehart SM Dorner W Standards of training for Physicians for the use of lasers in Medicine and Surgery American Society for Laser Medicine and Surgery Inc J Am Acad Dermatol 1995 33 265 70 Hayman MR Accreditation of the Office Based Surgical Facility Am Coll Surg Bull 1995 80 8 11 Alam M Who is qualified to perform laser surgery and in what setting Semin Plast Surg 2007 21 193 200 Lomando K Faulconer DR A workable plan for OR quality assurance AORN J 1982 35 1291 5 Olson R Continuous power to the OR and other critical care areas Dimensions Health Serv 1975 52 29 30 Beck WC Lighting the surgical suite Contemp Surg 1978 12 9 13 Kerr DR Electrical design and safety in the operating room and intensive care unit Int Anesthesiol Clin 1981 19 27 48 Klebanoff G Operating room design Am Coll Surg Bull 1979 64 6 10 Bennett RG Textbook of Fundamentals of Cutaneous Surgery In Bennett RG editor illustrated St Louis CV Mosby 1988 p 181 93 Garner JS Favero MS Hospital Infections Program Center for Infectious Diseases Centers for Disease Control and Prevention Antiseptics handwashing and handwashing facilities Wash
8. can be a good alternative fitted preferably in roof or on wall near treatment end Switches for each tube should be separate so that the required level of illumination can be selected A headlight may be used for fine procedures The surgeon s chairs should have adequate back and foot support and should be movable with wheels Waste bin metallic washable with lid and polythene disposable bag inside should be preferred Laser Room Shelf planning A cupboard with non reflective surface to store equipments and consumables is essential Provision for wall cabinets to house consumables and Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 Dhepe instruments can be made to clear the floor space The depth of the cabinets could be around 1 foot Treatment kits Plastic trays with all consumable and preparation material should be kept ready in a tray In a busy treatment centre with many procedures being performed daily 4 to 6 such trays for each procedure may be kept ready so that it saves time of preparation before starting procedure A sample treatment kit for Laser hair removal may include Razor hypo allergic micro pore tape marking pen antiseptic soothing ointment frozen ice packs patient external eye shield a printed post treatment instruction sheet EMLA cream tube etc Equipments Level of Evidence Level B e Maintenance Three important pre requisites for longer life of laser machines are
9. not point the laser or fiber directly at any person s face The laser fiber will always be handled as a loaded gun and pointed in a safe direction in the event of an accidental firing Table 2 Selecting laser safety glass Common lasers OD goggle for OD goggle for used treating physician patients Excimer T T IPL Leo 320 3 5 IPL Leo 420 3 5 IPL Leo 540 3 5 IPL Leo 570 3 5 IPL Leo 650 3 5 ST infrared laser 3 5 LP1064 Nd YAG gt 7 gt 7 QS Nd Yag gt 7 gt 7 Erbium Yag 6 6 Pixel Er Yag 6 6 Light sheer Diode 6 6 Soprano 6 6 Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe Eyewear and filters should be without defect Frames should not be broken and separated from the lenses Side shields if optionally used should be in place and no scratches should be on the front lenses The laser operators or safety officer will make periodic inspections for these defects A wet gauge should be wrapped on and around eyes when laser is used near eyes Goggles should be adequately cleaned between treatments Internal eye shield In the event the laser must be used directly on the eyelid or within the bony orbit of the eye appropriate laser safety eye shields will be placed between the lid and eye to provide protection Internal eyeshields are metallic and laser opaque
10. reflections of the beam from reflecting objects close to the beam path and pay particular attention to the possibility of exposure of their own skin to the laser Whenever the laser is not under use it must be switched off and the key withdrawn and placed in safe custody by the Authorized Operator Lasers should be checked for proper operation and test fired prior to each procedure The laser should be placed in the standby mode whenever it is not being fired to prevent accidental firing into the field prevent accidental fires and preclude accidents that could occur if the laser and other foot pedals are confused and fired during a procedure The operator the person applying the laser to the skin and no other person should control the laser foot pedal or hand switch The laser foot pedal should be situated separately from other foot pedals such as electro surgery or microscope controls If oxygen is to be administered with in laser room in an emergency minimum concentration of oxygen preferably below 40 should be used to oxygenate the patient with a laser resistant oxygen chamber Fire precautions The CO laser presents higher risk for ignition of dry and inflammable materials and appropriate precautions should be taken when necessary such as the use of moistened towels or sponges to drape the perimeter of laser treatment areas and avoiding or protecting hair lines that might have hair spray or inflammable prep solution
11. This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Minimum standard guidelines of care on Member Dermatosurgery taskforce IADVL SkinCity Post Graduate Institute of Dermatology and Lasers Solapur Maharashtra India Address for correspondence Dr Niteen V Dhepe SkinCity Post Graduate Institute of Dermatology and Lasers Employment Chowk Solapur Maharashtra India E mail niteendhepe yahoo com requirements for setting up a laser room Niteen Dhepe ABSTRACT Introduction definition rationale and scope Lasers are now becoming an integral part of dermatological practice in India with more and more dermatologists starting laser dermatology practice Lasers when are used with care by properly trained operators in carefully designed environment can deliver a range of useful aesthetic and dermatologic treatments Facility Laser treatment is an office procedure hence it does not require hospital set up The laser room facility requires careful planning keeping in mind safety of both patient and operator convenience of operating and optimum handling of costly equipments The facility should be designed to handle procedures under local anesthesia and sedation Facilities staff and equipment to handle any emergencies should be available Location A room in existing dermatology clinic can be adequately converted to a laser room Dimensions of laser room
12. Xylocaine drops are essential for anesthesia Neosporin eye ointment applied before insertion and after removal of the internal eye shields Suitable size as per age of patient is selected small medium and large Accident Procedure If an actual or suspected incident of eye exposure to laser happens an eye examination should be carried out within 24 hours by an ophthalmologist The same should be recorded Staff training There should be periodic review training of staff with respect to Power failure protocol Fire protocol Employees know location of fire extinguishers evacuation procedures and whom to call Adequacy of sterilization Periodic checking of autoclave function Availability and currency of medical supplies Proper functioning of all monitoring equipment Items are periodically turned on and tested Dermatosurgical operation theater guidelines Surgical laser procedures like CO laser or Er YAG laser full face resurfacing where relatively more raw area is expected should preferably done in dermatosurgical minor theater IADVL guidelines on dermatosurgery theatre provide details on this subject and may be referred 31 REFERENCES Alster TS Getting started setting up a laser practice In Alster TS editor Manual of cutaneous laser techniques 2nd ed Philadelphia Lippincott Williams and Wilkins 2000 p 2 4 Dover JS Arndt KA Dinehart SM Fitzpatrick RE Gonzalez E Guidelines of care for laser surgery
13. a maximum of 15 references at a time e If the reference is correct for its bibliographic elements and punctuations it will be shown as CORRECT and a link to the correct article in PubM ed will be given e If any of the bibliographic elements are missing incorrect or extra such as issue number it will be shown as INCORRECT and link to possible articles in PubMed will be given 110 Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 Be on the top with Lumenis Only company with direct presence in India O Best in class Lasers LightSheer and Ultrapulse Q Strong Service Network in India io Comprehensive clinical trainings from renowned clinicians Q Strong Base of Users in India Q LUMENIS Enhancing Life Advancing Technology For more information please contact Lumenis India Pvt Ltd 308 309 310 3rd Floor Suncity Business Tower Golf Course Road Sector 54 Gurgaon 122 002 Haryana India Tel 91 1244854902 M 91 8800411599 Fax 91 1244854932 Email shantanu bhatnagar lumenis com India Service Helpline 0124 4210795 Email customercareindia lumenis com
14. apulse Laser Laser room guidelines they require separate electric circuit e Provision should be made for ice cubes or ice packs e Cooling gel packs are better alternative to ice cooling e Measuring devices measuring tape measuring scale vernier caliper various moulds for measurement of venous diameter infra red thermometer are some of the pre treatment measuring devices which help to document results objectively Mobile laser unit Level of Evidence Level D In India laser machine is often shared between different clinics So machine needs to be shifted from one clinic to other clinic and one city to other city In the economics of the Indian situation this is both essential and also unavoidable The taskforce therefore recommends that mobile laser units are acceptable However the following guidelines are recommended for establishing a mobile laser unit e Lasers with articulated arm delivery system whose output is reflected through series of fitted mirrors are not recommended to move from the place of installation e However most of the newer laser devices come with fiber optic delivery system and can therefore be made mobile e Option of making laser mobile should be thoroughly discussed with supplier and an assurance of support for mobility in writing is obtained if machine is in the warranty period e Annual maintenance contract AMC done after warranty period is over should include clause of mobility su
15. are on requirements for setting up a laser room Indian J Dermatol Venereol Leprol 2009 75 Suppl 2 101 10 Received September 2008 Accepted October 2008 Source of Support Nil Conflict of Interest None declared ndian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 101 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe Laser room guidelines Records Patient s health declaration questionnaires laser register are essential records Digital photography before and at regular intervals after procedure is an essential record Detailed informed consent in patients language for each procedure explaining nature of procedure anesthesia used and machine used post operative down time should be signed by patient Drugs anesthesia and sterilization An electrocautery machine to control bleeding equipments for airway maintenance other instruments for emergency resuscitation and an emergency drug tray are essential Standard sterilization practices are adopted For most of laser procedures topical anesthesia is sufficient Safe laser use Protocols of safe laser use to avoid burns or eye damage to patients or operator are adopted Reflective surfaces like mirrors reflective jewelleries are not allowed in laser room Machine should always be on standby mode when not in direct use It should be used by authorized operator only Eye protection Goggle
16. d near machine Outer surface of device is to be cleaned with spirit swab or acetone swab Cables of machines to be checked for snug fitting after cleaning Laser tips touching patients skin should be cleaned before using for other patient IPL Intense Pulse Light tips to be cleaned of gel with spirit swab Covers of IPL filters to be cleaned off gel Unclean IPL glass filters can catch fungus and turn opaque blocking output Sterilization Level of Evidence Level A Minimum emergency equipments 1 Adequate procedures that ensure appropriate sterilization or disinfection of instruments and equipment should be in place 1151 Steam dry heat or gas sterilization is recommended for critical instruments Instruments and surgical sets are stored in dry sterile dated packs A blood pressure measuring device should be available Traditional sphygmomanometer plus stethoscope or automatic system additional cuffs for large The following drugs need to be maintained DRUGS Quantity Table 1 Emergency medications Xylocaine without adrenaline 5 Xylocaine with adrenaline 5 Adrenaline 1 1000 5 Atropine 0 6 mg 5 Sodium bicarbonate ampoules 2 Chlorpheniramine maleate 22 75 mg ml 2cc 2 Hydrocortisone 100 mg ml 2 EMLA Eutectic Mixture of Local Anesthetics 10 106 Laser room guidelines and pediatric patients are available Emergency medications Table 1 like hydrocortisone acetate
17. diagnosis anesthesia planned pain involved and instrument being used laser or electro surgery post operative care including the necessity of dressing sunscreens or antibiotics complications expected and their remedy The next follow up should be informed prior If the patient is receiving oral sedation the necessity of an attendant after surgery should be prior informed The cost of the therapy should be explained e Use of mobile telephones in the laser room should be restricted Safe operation practices and emergency protocols Evidence Level B e Before administering local anesthetic agents Obtain history of xylocaine hypersensitivity and usage of beta blockers aspirin vitamin E or Ginkobiloba or any other anti platelet drug 1922 e Never pass electrical cables over the patient e Avoid using spirit immediately before laser e Before laser surgery wear surgical mask The pore of the mask should be less than 1 0 micron The mask should be covering the nose and mouth Never put the used mask in your apron pocket e Smoke evacuator is necessary to suck out laser fumes which can contain HPV and other viruses or potent carcinogens and lung irritants Plumes of viral infection can cause laryngeal papilloma Surgical plumes have contents similar to other smoke plumes including carbon monoxide polyaromatic hydrocarbons and a variety of toxic gases As such they can produce upper respiratory irritation and have in vitro muta
18. from inside to have uninterrupted exit in case of emergency e Laser warning sign to be fixed outside the treatment room Floor and walls Flooring Cleansing disinfection e The flooring should be easily washable kept clean at all times e Cleaning of laser room must always be supervised by authorized laser operator and care must be taken to protect laser devices and electrical sockets from water Avoid washing in laser room e Washing area may be attached to the laser room but should not be located within it There should be an adequate wash hand basin hot and cold water with long wing taps with long handle And adjacent soap and paper towel dispenser Mains drainage must be in place e Reflective surfaces should be avoided walls ceilings and worktops etc Electrification and uninterrupted power supply Level of Evidence Level B e A three phase electric connection is preferable if multiple laser and or cooling devices are used 7 e Higher capacity meter is fed with thicker and stable cables and is preferred Electrical load is calculated on starting load of the equipment which is usually double the labeled working load Starting load may be calculated by using ampere meter Ammeter device Avoid lower capacity meter fed by thin cables which in case of overload or under load may melt and cause damage to equipments e Each socket board should be secured by proper earthing or grounding Ungrounded connection decreases mach
19. genic potential e Smoke evacuator contains a filter to adsorb these particulate matters e Smoke evacuator should have specific attributes suction unit or pump filter hose and inlet nozzle The capture velocity should be about 100 150 feet per minute at the inlet nozzle The filter should be high efficiency particulate air filter HEPA The inlet nozzle should be held about 2 inches above the operation site PRINCIPLES FOR NON PHYSICIAN LASER USE EVIDENCE LEVEL D e Only a fully qualified dermatologist who has trained himself in safe use and operating of laser can appoint a laser operator 107 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe A properly trained authorized laser operator may carry out nonsurgical and non ablative laser procedures only under his direct supervision The ultimate responsibility of procedure done by operator though trained lies with the treating dermatologist Hence independent use of laser by non physician operator is discouraged METHODS OF SAFE WORK EVIDENCE LEVEL B Reflective jewellery worn by the operator and the patient should be removed before the treatment is commenced 5 Other dermatological procedures and activities must not take place in the laser room while the laser is in use When the laser is used the number of persons in the room shall be kept to a minimum The Operator should be careful to avoid
20. ines productive life In addition it may also be associated with a risk of electric shock to the operator e Imported machine cables may not be supplied with a grounding pin and this may need to be provided separately e Three cables from each power plug 15A 5A should run uninterruptedly to circuit breaker on a control panel Individual circuiting of plugs protect other 103 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe machines in case of short circuit accident in one plug Each wall of laser room should have two panels with two plugs one 5 A and one 15A each Plug panel should be fitted in each corner one foot off ground and 2 feet away from corner At least five plug panels to be fitted in a laser room It is possible that the same patient may need to be treated with more than one machine in the same session During such procedures crossing of equipment probes or cables over the patient is not advised No extension cords should be used in the laser room as they don t have grounding most of the time If at all one needs extension it must be custom made with grounding and all cable connections tightly fitted Continuity of grounding cable from machine to underground attachment must be confirmed periodically A poorly grounded circuit is a silent killer of machine s capacity Always use servo stabilizer for lasers A laser machine should not be
21. ington DC US 1985 Available from http wonder cdc gov wonder prevguid p0000412 p0000412 asp accessed on 2008 Aug 31 Centers for Disease Control Recommendations for prevention of HIV transmission in health care settings Morbidity Mortality Wkly Rep 1987 36 1S 18S Simmons BP Guidelines for hospital environmental control Infect Control 1982 2 131 7 Stegman SJ Tromovitch TA Glogau RG Text book of Basics of dermatologic surgery Chicago Year Book medical publishers 1982 p 1 22 Yakel ME Cummins RO editors Illustrated Textbook of advanced cardiac life support 2nd ed Dallas American Heart Association 1994 p 267 Gilbert DA Adamson JE Procedure manuals in office surgery Clin Plast Surg 1983 10 269 Holzman RS Cullen DJ Eichhorn JH Guidelines for sedation by nonanesthesiologists during diagnostic and therapeutic procedures J Clin Anesth 1994 6 265 76 American Medical Association Standards and guidelines for cardiopulmonary resuscitation CPR and emergency cardiac care ECC J Am Med Assn 1986 255 2905 84 Sebben JE Fire extinguishing systems and electrosurgery J Am Med Assn 1987 17 854 5 Sebben JE Sterile technique and the prevention of wound infection in office surgery J Dermatol Surg Oncol 1988 14 1364 71 Sebben JE Sterilization and care of surgical instruments and supplies J Am Med Assn 1984 11 381 92 Standards of Training for Physicians for the Use of Lasers in Medicine and Surgery A
22. l software is a futuristic trend but remains optional at this time Laser treatment register recording of parameters and relevant findings on a tabular form for subsequent visits A common procedure register used for other dermatosurgical procedure can be used if enough space or columns to record laser specific parameters is provided A consent form with a questionnaire is covered in a patient s information sheet filled by the patient or a family member Any contraindications or sensitivity should be brought to notice of treating dermatologist A separate day book with records of the date Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 Dhepe name of patient diagnosis treatment given and charges may be maintained It may be useful for income tax audits Consent The consent form should have e The Name of the institute where the therapy would be carried out e The patient name and treating dermatologist name should be mentioned e Diagnosis of the condition e Treatment options available and justification of the chosen intervention e The type of anesthesia being used e Post operative care required e Possible complications of the surgery and remedies for the same e Consent for photo in the same form A model consent form is attached in annexure Photography e A digital photograph in standardized condition is the most important document of record e A good quality digital camera wi
23. merican Society for Laser Medicine and Surgery Inc 1991 Available from http 72 14 235 132 search q cache mWAwjHkKpmsjJ www lasertraining org Administrative Library Laser 2520Policies 2520 25200f fice 2520DermatologyAesthetic 2520Sample 2520Policie 2520Feb06 doc andhl enandct clnkandcd 1andgl in Accessed on 2008 Aug 31 Sebben JE Survey of sterile technique used by dermatologic surgeons J Am Med Assn 1988 18 1107 13 Sebben JE Surgical antiseptics J Am Med Assn 1983 9 759 65 Chuang LH Lai CC Yang KJ Chen TL Ku WC A traumatic macular hole secondary to a high energy Nd YAG laser Ophthalmic Surg Lasers 2001 32 73 Elias B Lasers aimed at aircraft cockpits Background and possible options to address the threat to aviation safety and 109 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe 28 29 security CRS Rep Congress 2005 1281 1350 Available from http www fas org sgp crs RS22033 pdf Accessed on 2009 Aug 28 Breitenbach RA Swisher PK Kim MK Patel BS The photic sneeze reflex as a risk factor to combat pilots Mil Med 1993 158 806 van Norren D Keunen JE Vos JJ The laser pointer no demonstrated danger to the eyes Ned Tijdschr Geneeskd 1998 142 1979 82 Available from http translate google co in tran slate hl enandsl nlandu http www ntvg nl node 294932 Author Help Reference checking facility 30
24. n should comply with any existing state and local fire safety sanitation and building regulations Location e The room in which the laser is used is called a Controlled Area e Itis recommended that only one patient be treated at any given time in the laser room At no time more than one patient or procedure at the same time in same room is allowed e A sign must be fitted to the door of the room with the wording CONTROLLED AREA LASER e The following notice must be fixed to the laser machine itself This device must be used by an Authorized Operator only Dimension e Laser room has to accommodate patient chair length 6 feet and width 2 5 feet a trolley carrying the laser machine about 3 feet x 3 feet a cart carrying cooling device about 2 5 feet x 2 5 feet a laser operator and at least one assistant The ideal dimension should be 12 feet by 12 feet The room should allow free movement of operator for proper Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Laser room guidelines positioning of laser probes Laser room door e Door should be of 3 feet width for easy movements of laser machines with its trolley e The door should be made of opaque material This is to prevent transmission of laser light e The lock should always have preferential access
25. oom Dust free and cool environment with well grounded and uninterrupted power supply are necessary for machines working life Air conditioner AC requires 3 phase electric meter connection Phase feeding AC and laser equipment should be separate so that turning on and off AC will not cause fluctuation in input of laser The phase which has less power cut in load shedding period reliable phase may be connected to laser circuit and other unreliable phase to be spared for AC Treatment chair operator chair light and illumination Evidence level Level C It is preferable to have a treatment chair with movable sections Recommended dimensions include 6 feet length 22 24 inches breadth to allow the patient to be positioned properly so the operating team can maintain the airway quickly alter position of the patient in an emergency and provide a firm platform for the management of cardiopulmonary resuscitation A dental chair cosmetic chair ophthalmic chair with manual or electric manipulation may all be used Facility of syncope position is preferable in the treatment chair as it helps immediate resuscitation in case of vaso vagal attack A foldable cosmetic chair used in beauty parlors can be a cheaper option for most of laser procedures except for certain procedures on neck An adjustable task light either fitted on the dental cosmetic chair or situated separately is preferred Four 40 watt fluorescent tube lights
26. plugged directly on without a stabilizer and or UPS A back up lighting system must be of sufficient intensity to permit the completion of any procedure under way at the time of general power failure The back up system is periodically checked battery packs high intensity flashlights or back up generators may be used UPS Uninterrupted power supply online as well as off line is recommended in Indian power supply conditions UPS should be of 3KVA or more minimum 2 5 KVA with 16 batteries of 60 to 100 Ampere capacity each Voltage KVA determines what load UPS can take and battery capacity determines length of power support when mains are off UPS and batteries should be installed in cool and ventilated space High ambient temperature deteriorates battery life and quality of UPS support In laser room points fed by UPS and those fed by stabilizer only or directly from mains should be labeled separately Plugging high voltage devices like Zimmer cryo cooling device devices with compressor accidentally to UPS points may trip UPS affecting function of laser machine already on UPS Windows and ventilation All outside air openings to the surgical area are secured against the entrance of insects or other animals Windows are screened or closed 104 Laser room guidelines Air conditioning e Most laser machines require ambience temperature 18 22 C for normal functioning and hence the need for air conditioning the laser r
27. pport e Insurance Usual and routine insurance policies do not cover risk of mobility A special tailor made insurance policy subject to the locations of transport and modes of transport may be designed after discussion with the insurance companies though this may attract a higher premium rate also called special contingency insurance e Machine should be transported in original manufacturer s packing case designed for shipping e Ifaspecial case is to be designed PU polyurethane foam instead of regular PE polyethylene foam with adequate thickness at bottom min 6 inches is recommended e Authorized laser operator should accompany the machine all the time always 105 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Dhepe Servo stabilizer and or UPS should be available at other facility where mobile laser is to be used The other clinic also should have class 1 facility Local Regulation Octroi and entry tax is prevalent in municipal corporation areas in some states Copies of octroi payment at original location and prior permission of transport from both the municipal corporations is to be obtained every time Cleaning of laser and other devices Laser machine is to be cleaned periodically as per the instruction in its user manual by authorized operator only No other staff should touch the machine for cleaning purpose No water is to be use
28. s dried in 108 Laser room guidelines the hair line Staff should be aware of the location of office fire extinguishers e A fire extinguisher with ISI mark should be available The dry chemical type is most common for general office use For surgical areas consider a non residue type fire extinguisher such as Halon or carbon dioxide LASER EYE PROTECTION EVIDENCE LEVEL B e Lasers have been classified by wavelength and output power into four classes from class 1 no hazard during normal use to class 4 severe hazard for eyes and skin Medical lasers belong to class III b and IV lasers requiring eye protection gt 26 311 e Appropriate protective eyewear is required for all persons within laser procedure room during laser use The IPL though not a laser will also require appropriate safety glasses to be worn by personnel within the room ANSI 136 3 e The safety glasses must be specific to the wavelength of the laser being used Protective eyewear should be labeled according to the optical density and wavelengths filtered Table 2 Safety glasses for the IPL unit should be the generic IPL safety eyewear or the more specific light speed eyewear e Viewing laser or IPL operation through a video monitor offers no risk to the viewer in any situation e Safety glasses or filters cannot offer eye protection against a direct close range impact through the safety material into the eyes Laser operator will therefore
29. s of sufficient optical density OD intended to protect from specific laser wavelength are to be used by all persons in laser room Patient is given either same goggle or laser opaque shield For procedures around eyes or on eyelids internal eye shield made of laser opaque material are to be used Fire extinguisher complying with local authority fire rules should be available and staff should be trained to use that Safety and emergency protocols Protocols for certain situations like vasovagal attack anaphylaxis uncontrolled bleeding fire accidental eye exposure should be in place and staff should be trained for these situations Key words Guidelines Laser Procedure room INTRODUCTION Lasers are now becoming an integral part of dermatological practice in India Many dermatologists starting new dermatology practice seek to include lasers in their practice Definition Rationale and scope e Lasers when used with care by properly trained operators in carefully designed environment can deliver a range of useful cosmetic treatments This calls for establishing minimum standards at the national level with the main focus on patient safety and hence the scope of guidelines These guidelines are of general nature and may need to be interpreted and adopted in the context of individual situations These guidelines are based on the available evidence in this rapidly evolving field and may need changes as per future research and publications
30. ssential for insurance purposes Mobile Laser Unit Mobile laser units are of relevance in the Indian context to render laser facility available in smaller towns A laser with fiber optic delivery system can be made mobile after consultation with supplier However a laser with an articulated arm delivery cannot be made mobile Proper packing with shock absorbing material is necessary during transportation The area where lasers are to be moved to and operated should have appropriate facilities as mentioned above LEVEL OF EVIDENCE IADVL Taskforce 2008 09 consisted of the following members Dr Venkataram Mysore coordinator Dr SC Rajendran Dr Sharad Mutalik Dr Niteen Dhepe Dr Sujay Khandpur Dr Sanjeev Aurangabadkar Ex officio members Dr S Sachidanand President IADVL Dr VK Sharma President elect IADVL Dr Chetan Oberai Past president IADVL Dr Rajeev Sharma Secretary IADVL Level A Strong research based evidence multiple relevant high quality scientific studies with homogeneous results Level B Moderate research based evidence at least one relevant high quality study or multiple adequate studies Level C Limited research based evidence at least one adequate scientific study Level D No research based evidence expert panel evaluation of other information For disclosures and disclaimers please refer to the table of contents of this supplement How to cite this article Dnepe N Minimum standard guidelines of c
31. th more than 4 megapixel MP resolution both optical and digital zoom and variable ISO is recommended e A digital SLR is a luxury and can be very useful for very busy laser practices who can afford a full time medical photographer e The following parameters should be maintained constant patient position distance of camera light illumination photographer and background Laser Practices e The physician and appropriate staff should be familiar with basic CPR and be able to administer it properly e The staff should be instructed about potential hazards associated with their duties and know how to minimize risks This includes applicable OSHA regulations e g hepatitis B virus and HIV exposure bacterial contamination sharps hazards and hazardous chemical or drug exposures e The staff should be trained about the proper disposal of medical waste and other bio hazardous material e All applicable central government state and local regulations should be followed Etiquettes e A female staff or attendant should always be present while examining or treating a female patient Indian J Dermatol Venereol Leprol July August 2009 Vol 75 Suppl 2 This downloaded PDF Article is supported by LUMENIS the makers of World s renowned LightSheer and Ultrapulse Laser Laser room guidelines e Patients privacy modesty and dignity should be respected by all staff at all times e Patient must be explained in detail about the
Download Pdf Manuals
Related Search