Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
This slide presentation has been prepared for Temple University Health System and is intended only for use by it’s faculty, staff and students.
All questions pertaining to this presentation should be directed to EHRS.
Environmental Health & Radiation Safety
Temple University
byDr. Eyas Amr
Senior Laser Safety Officer
LASER SAFETYTRAINING FOR TUHS
EMPLOYEES
UNDERSTANDING LASER SAFETY
What is a laser?
What are the potential hazards?
How can these hazards be prevented?
In order to understand laser safety the following questions need to be answered:
WHAT IS A LASER?
LA
SE
R
ightmplification by
timulatedmission of
adiation
The light emitted by a laser is non-ionizing electromagnetic radiation, that is, ultraviolet, visible, or infrared light
WHAT IS A LASER?Stimulated Emission
Incident Photon
Excited Atom
Stimulated Photonsame wavelength
same directionin phase
Incident Photon
LASER BASICS
- Laser light differs from ordinary lightin 3 ways:
- Monochromatic
- Directional
- Coherent
- These three properties allow a laser tofocus a lot of energy onto a small area
DEFINITIONS:
Monochromatic - one single color or wavelength.
Directional - Collimated, traveling in one direction
Coherent – all the individual waves of light are moving
precisely together through time and space,
i.e. they are in phase.
LASER BASICS -DESIGN
Feedbackmechanism
Outputcoupler
Lasing medium
ACTIVE (LASING) MEDIUMSolid (Crystal)
GasSemiconductor (Diode)
Liquid (Dye)
EXCITATION MECHANISM
Optical ElectricalChemical
OPTICAL RESONATOR
HR Mirror andOutput Coupler
The Active Medium contains atoms which can emit light by stimulated emission.
The Excitation Mechanism is a source of energy to excite the atoms to the proper energy state.
The Optical Resonator reflects the laser beam through the active medium for amplification.
Laser Temporal Outputs
The Electromagnetic Spectrum
The Electromagnetic Spectrum
Region Wavelength
Ultraviolet (UV) 100 to 400 nm
UV-C 100 to 280 nm
UV-B 280 to 320 nm
UV-A 320 to 400 nm
Visible (Light) 400 to 700 nm
Near Infrared 700 to 1400 nm
Far Infrared 1400 nm to 1 mm
LASER Classification
Lasers and laser systems are assigned one of the four broad classes (1 to 4) depending on the potential for
causing potential damage.
• Class 1: "safe" if not disassembled. Example: Laser printers, CD-Rom players/drives
• Class 1M: is safe for all conditions of use except when passed through magnifying optics such as
microscopes and telescopes. Examples: Fiber-optic communication systems.
LASER Classification
• Class 2: dangerous if viewed more than 0.25 seconds, but still does not pose significant eye hazards. Example: Supermarket scanners
• Class 2M: is safe because of the blink reflex if not viewed through optical instruments. Eye is protected by blink reflex if not viewed by optical instruments. Example: level and orientation instruments for civil engineering applications
LASER Classification
• Class 3R: is considered safe if handled carefully, with restricted beam viewing. Direct intrabeam viewing is potentially hazardous. Visible continuous lasers in Class 3R are limited to 5 mW. Example: alignment lasers.
• Class 3B: eye hazards if beams are viewed directly or specular reflections are viewed. Example: research
LASER Classification
• Class 4: eye hazards if beams are viewed directly or specular reflections and sometimes even from diffuse reflections. The power output for class 4 is above 500 mW. Skin burns from direct beam exposure. Example: research lasers, manufacturing, and medical lasers
Viewing Laser Radiation
Figures 1, 2, 3 below illustrate the different ways laser radiation can be viewed and therefore the different types of exposures an individual may encounter.
Figure 1. Intrabeam viewing of direct (primary) beam. This type of viewing is most hazardous. Note that the diagram also illustrates that a laser beam may diverge as it propagates.
Viewing Laser Radiation
Figure 2. Intrabeam viewing of a specularly reflected (secondary) beam from a flat surface reflector.
Viewing Laser Radiation
Figure 3. Diffuse viewing of a diffusely reflected (secondary) beam from a rough surface in which a collimated beam is reflected in all directions.
Laser Exposure Limits
Maximum Permissible Exposure (MPE): is defined as the level of laser radiation to which a person may be exposed without hazardous effect or adverse biological changes in the eye or skin. The MPE of a specific laser is determined based on the wavelength and exposure duration.
Laser Exposure Limits
Nominal Hazard Zone (NHZ) is the space within which level of the direct, reflected, or scattered radiation during normal operation exceeds the applicable MPE. Exposure levels beyond the boundary of the NHZ are below the appropriate MPE level.
TWO TYPES of LASER HAZARDS
- Non-beam related
- Beam related hazards
NON-BEAM RELATED HAZARDS
Hazards associated with the generation of the laser beam
- Electrical
- Chemical
NON-BEAM RELATED HAZARDS
- Electrical- High voltage – many lasers require high voltage to generate the laser beam
- Accidental exposure can result in electrical shock or death
- Chemical- Dye lasers use hazardous dyes to generate the laser beam- These dyes can be toxic or carcinogenic and require proper disposal
BEAM RELATED HAZARDS
Hazardous effects related to unintentional direct contact with the laser beam
-Skin related
-Eye related
-Interaction hazards
INTERACTION HAZARDS
- Laser Generated Airborne Contaminates (LGAC)
- Fire and explosion
LGAC (Plume)
- Plume - smoke from vaporization
- Creates a visibility problem
- Can cause nausea
- Potential health hazard
LGAC (Plume)
Types of LGAC
- Carbon
- Aerosolized blood- Bacteria
- Viral particulates
-Gases – including benzene, tolueneand formaldehyde
FIRE AND EXPLOSION
Can occur if the laser beam comes into contact with combustible or volatile materials, such as:
- gauge pads- surgical drapes- gowns- alcohol - anesthetic gases- plastic trach tubes- rectal gases
BEAM RELATED EFFECTS
- Skin related - most skin damage caused by the laser is temporary
- Eye related – most eye damage caused by thelaser is usually permanent
SKIN RELATED
- Thermal burn- Laser effects on tissue are dependent
on 4 factors:- power density of laser beam- wavelength- duration of exposure- effects of circulation and conduction
Skin Hazards
• UV-C (200 - 280 nm): erythema (sunburn), skin cancer • UV-B (280 - 315 nm): accelerated skin aging, increased
pigmentation • UV-A (315 - 400 nm): pigment darkening,
photosensitive reactions • Visible (400 - 780 nm): photosensitive reactions, skin
burn • Infrared (900 nm - 1 mm): skin burn
EYE RELATED
- Injury can result from exposure to a:- direct beam- mirror reflection (surgical instruments)- diffuse beam (tissue reflection)
- Damage is dependent on:- intensity - lens of the eye can focus beam onto
the retina (dye laser)- wavelength - absorbed by different parts of
the eye (CO2 - cornea, sclera)- duration - fraction of second, before you
can blink (aversion response)
The human eye can focus even a low-power laser beam to a tiny spot on the retina increasing its energy up to 100,000 times
Eye Hazards
The image below shows the site of damage dependence on the wavelength of the incident or reflected laser beam
Eye Hazards
• Visible (400 - 700 nm) and Near-Infrared wavelengths (700 - 1400 nm) are focused by the cornea and lens and are absorbed by the retina. This may result in a fovea burn which may be considered one of the most serious types of laser injuries.
• Mid-Infrared and Far-Infrared (1400 nm - 1mm) wavelengths and Mid-Ultraviolet (180 - 315 nm) are absorbed by water on the surface of the eye.
• Near-Ultraviolet (315 - 390 nm) wavelengths are absorbed in the cornea and lens structures.
PREVENTION
- The potential laser hazards discussed must be
eliminated or controlled for the safe use of
lasers in the medical arena
CONTROL MEASURES
- Engineering
- Personal protection
- Administrative
There are 3 basic control measures:
ENGINEERING
There are control measures that are built into the laser system, such as:
- enclosing the electrical system, withina cabinet
- enclosing the beam within fiber opticsor mechanical arms
PERSONAL PROTECTION
- Eyewear
- Barriers
- Smoke evacuation & filtration
- Fire protection
EYE PROTECTION
- Each laser requires specificeyewear that is capable of absorbing laser light of that specific wavelength
Proper Optical Density (OD) and Proper Wavelength (λ)
Eyewear
EYE PROTECTION
EYE PROTECTION
- Everyone in the laser OR must wear eye protectionincluding the patient
EYE PROTECTION
-Patient – the patient’s eye’s can be protected by:- covering with moist towels- goggles- intra-ocular shields
-The surgeon must have eye protection, evenduring microscopic and endoscopic procedures.
-Lens filters that fit over the eyepiece can be used
SKIN PROTECTION
- Clothing- Gloves- Fire resistant gowns- Fire resistant surgical drapes- Moist gauze and drapes around surgical area
Barriers
Offers some protection from skin exposure to laser beams, unfortunately most OR’s use flammable gowns and drapes thus increasingthe potential for fire hazards- all gauze and drapes around the surgical areashould be moistened with sterile saline.
- commercially available nonflammable gownsand drapes designed for laser surgery should beused when possible
Clothing
SKIN PROTECTION
FIRE PROTECTION
- Adequate fire extinguisher available- Sterile saline or water near by-A fire resistant endotracheal tube should be used
for all oral and tracheal procedures-For lower bowel procedures the rectum may be
packed with a wet sponge-Moist gauze and drapes used around surgical
area-Non explosive anesthetic gases must be used
SMOKE EVACUATION & FILTRATION
Commercially available smoke evacuators filter outthe smallest particles (0.1 µ) found in the laser plume
- to be completely effective the smoke evacuatorsuction tube must be placed as close as possible to
the site of laser ablation (less than 2 cm)
SMOKE EVACUATION & FILTRATION
Filtration
-HEPA (high efficiency particulate air) Filter-99.99% efficient at filtering 0.3 micron particles-Bacterial filter
-ULPA (ultra-low penetration) Filter-99.999% efficient at filtering 0.12 micron particles-Viral filter
ADMINISTRATIVE CONTROLS
- Controlled entry
- Education
- Standards
CONTROLLED ENTRY
- Closing doors and covering windows
- Door interlocks – automatically switches laser to standby if doors are opened
- Posting of “Laser in Use” signs outside all entries
EDUCATION
All personnel that may be exposed to the laser shall be required to attend regular“in-services” on operating the laser and laser safety
STANDARDS
Each medical facility should develop their own set of operating standards. An important source of Suggested Standards to be followed is provided by the federal government in the“American National Standards For The SafeUse Of Lasers” and the “American National Standards For The Safe Use Of Lasers In The Health Care Facility”
Temple University Procedures & Policies
Institutional
Departmental
Institutional Procedures & Policies
• Temple University Laser Safety Manual Located on Environmental Health and Radiation
Safety websitehttp://www.temple.edu/ehrs/safety/laser-safety/LaserSafetyPolicies.asp
Educational & research laser use Laser use in Temple health care facilities Laser Registration form http://www.temple.edu/ehrs/safety/laser-safety/
Institutional Procedures & Policies
All Departments / Divisions must have policies & procedures addressing safety precautions for personnel
It is suggested for personnel to have a baseline eye exam
Medical staff shall be credentialed (written record)
Safety Precautions (based on ANSI)
Trained laser tech/nurse present to oversee laser safetyRecord all activity & report any incidentsPost laser signsPPE (eyewear, masks) worn by all presentUse of audible/visible alarmsLaser key removed after use (also OSHA)
Safety Precautions (based on ANSI)
All laser system repairs documented Rental lasersShall be inspected by Tech SupportTech from outside must provide credentialsProvide record of maintenance & repair
Laser Safety Survey of TUHS Clinical and OR Laser Use Areas
All Health Care areas will be surveyed by EHRS The survey might take place during a laser
procedure The survey questions are based on Institutional
Procedures & Policies and Nursing Services/OR Policies
The following questions are typical of the type that will be asked during a survey
End of Training Session