Standard
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AS/NZS 4173:2018
[Current]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 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.
Published: 23/04/2018
Pages: 103
Table of contents
Cited references
Content history
Table of contents
Header
About this publication
Preface
Foreword
1 Scope and general
1.1 Scope
1.2 Application
1.3 Referenced documents
1.4 Definitions
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
2.1.8.1 Incident report
2.1.8.2 Equipment malfunction and personnel injury
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
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
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
A1 General
A2 Light
A3 Lasers
A3.1 Introduction
A3.2 What is a laser?
A3.2.1 General
A3.2.2 Laser medium
A3.2.3 Energy source
A3.2.4 Laser mirrors
A3.3 Modes of operation
A3.3.1 General
A3.3.2 Continuous Wave (CW)
A3.3.3 Pulsed mode
A3.4 Properties of lasers
A3.4.1 General
A3.4.2 Monochromaticity
A3.4.3 Low divergence
A3.4.4 Coherence
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
A4.8.1 General
A4.8.2 Eyes
A4.8.3 Skin
A5 Other ILS
Appendix B
B1 Scope of Appendix
B2 Use of optical fibres
B2.1 Hazard summary
B2.2 Precautions
B2.2.1 Fibre tip heating
B2.2.2 Fibre breakage
B3 Use of lasers with flexible endoscopes
B3.1 Hazard summary
B3.2 Precautions
B3.2.1 General
B3.2.2 Fibre cleanliness
B3.2.3 Use of gases
B3.2.4 Use of laser eyewear
B3.2.5 Internal fire risk
B4 Use of lasers with rigid endoscopes, microscopes and colposcopes
B4.1 Hazard summary
B4.2 Precautions
B4.2.1 Focal length
B4.2.2 Micro-manipulator
B4.2.3 Adhesion prevention
B4.2.4 Tissue protection
B4.2.5 Visibility
B4.2.6 Reflections
B4.2.7 Eye safety—Viewing system filters
B5 Use of lasers with free hand manipulation capability
B5.1 Hazard summary
B5.2 Precautions
B5.2.1 Attachment
B5.2.2 Tissue protection
B5.2.3 Fire prevention
B5.2.4 Metal objects
B6 Use of lasers in ophthalmology
B6.1 Hazard summary
B6.2 Precautions
B6.2.1 Reflections
B6.2.2 Protection of the untreated (contralateral) eye
B6.2.3 Fibre damage
B6.2.4 Direct delivery systems
B6.2.5 Dynamic filters
B6.2.6 Short focus devices
B6.2.7 NOHA
B7 Use of lasers in conjunction with anaesthesia
B7.1 Hazard summary
B7.2 Precautions
B7.2.1 Endotracheal tubes
B7.2.2 Oxygen concentration
B7.2.3 Nitrous oxide
B7.2.4 Protective eyewear
B8 Use of Class 3B and Class 4 lasers on the skin
B8.1 Hazard summary
B8.2 Precautions
B8.2.1 Skin response
B8.2.2 Tattoo removal
B8.2.3 Eye protection
B9 Use of Class 3B and Class 4 lasers in dentistry
B9.1 Hazard summary
B9.2 Precautions
B9.2.1 Surgery design
B9.2.2 Protection of non-target areas
B10 Photobiomodulation (PBM)
B10.1 Hazard summary
B10.2 Precautions
Appendix C
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
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
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
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
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
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
H4.2.1 Purpose
H4.2.2 Policy
H4.2.3 Procedure
H4.3 Policies and procedures for laser use—Fammability hazard and fire safety
H4.3.1 Purpose
H4.3.2 Policy
H4.3.3 Procedures
H4.4 Policies and procedure for laser use—Handling of fibre optic delivery systems
H4.4.1 Purpose
H4.4.2 Policy
H4.4.3 Procedures
H4.5 Policies and procedures for laser use—Laser generated airborne contaminants
H4.5.1 Purpose
H4.5.2 Policy
H4.5.3 Procedures
H4.6 Policies and procedures for laser use—Ocular safety
H4.6.1 Purpose
H4.6.2 Policy
H4.6.3 Procedures
H4.7 Policies and procedures for laser use—Test firing of CO2 lasers
H4.7.1 Purpose
H4.7.2 Policy
H4.7.3 Procedures
Appendix I
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
I2.5.1 Operational characteristics of lasers
I2.5.2 Laser hazards
I2.5.3 Principles and procedures for safe laser use
I3 Education and training—ILS
Appendix J
J1 Lasers
J1.1 General
J1.2 Laser wavelength
J1.2.1 Greater than 2500 nm
J1.2.2 Less than 2500 nm
J1.2.3 Holmium:YAG lasers (approximately 2100 nm)
J1.3 Irradiance or radiant exposure
J1.4 Fire/heat resistance
J1.5 Attachment/detachment
J2 ILS
Appendix K
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
K2.7.1 General
K2.7.2 OD, or optical density
K2.7.3 Wavelength
K2.7.4 Example
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
L1 General
L2 What is risk assessment?
L3 How is a risk assessment performed?
L4 Sources of information
Appendix M
M1 Laser safety committee
M2 Laser safety officer (LSO)
M3 Health care facility and equipment safety audits (Class 3B and Class 4)
Appendix N
Amendment control sheet
AS/NZS 4173:2018
Amendment No. 1 (2019)
Correction
Cited references in this standard
AS/NZS 3200
Medical electrical equipment (series)
NSW Health GL2015 002
Work health and safety—Controlling exposure to surgical plume
[Current]
Tracheal tubes designed for laser surgery - Requirements for marking and accompanying information
[Current]
Eye and face protection against intense light sources used on humans and animals for cosmetic and medical applications - Part 1: Specification for products
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