Key Takeaways: Guideline for Laser Safety

Preventing surgical fire in laser procedures

Medical lasers are commonly used in surgical and invasive procedures across a variety of settings, from offices and clinics to ambulatory surgery centers and hospitals. They are also used in different types of procedures, including dermatologic, urologic, neurosurgical, cardiovascular, and cosmetic.

• 1.11 All teams that perform procedures using lasers should be incorporating a laser time out – either as part of the procedural time out or separately – to make everyone aware of the use of the laser, and the necessary additional precautions to be taken.
• 3.2 Use technologies other than laser devices (e.g. bipolar electrosurgery, coblation technology, non-energy-applying instruments) when feasible and indicated by the fire risk assessment. ¹
• 3.3 Use water-soluble lubricants (e.g. eye lubricant) near the surgical site.^{7, 8}
• 3.4 Stop delivery of oxygen (O₂) or decrease the percentage to the lowest tolerable level before activating the laser near the patient’s head, face, or neck. 
• 3.5 Protect exposed tissues around the surgical site with moist materials (e.g. towels, sponges), and remoisten them as needed. ²
• 3.6 Use moistened radiopaque sponges or towels for rectal packing or for covering the anus during perineal surgery.³
• 3.7 Keep a basin of saline or water on the sterile field or within easy reach of the scrub person or the laser user if no scrub person is present.⁴
• 3.8 Instruct patients to avoid using hair styling products (e.g. hair spray, styling gel, mousse) on the day of surgery.^5,6

Every facility that uses lasers in procedures should have a designated Laser Safety Officer or Deputy Laser Safety Officer who oversees a safety program and laser use across their healthcare organization. Additionally, all members of the care team who are involved in laser procedures also should take annual safety training to ensure best practices are consistent and updated.

Additional Resources

Foundations of Laser Physics & Safety - a half-day, virtual live training to understand and implement evidence-based laser safety processes. This course meets annual team training requirements and provides foundational safety guidance to protect everyone in the room (3.25 CH/3.25 AEU). Next course is September 21, 2024 from 9:00am - 1:00pm ET. Register Now for Foundations of Laser Physics & Safety.

Medical Laser Safety Officer Course – a 1.5-day virtual, live advanced course for Medical Laser Safety Officers to ensure you have the most current information and tools to safeguard your colleagues and patients — and be successful in this important leadership role. Earn a Certificate of Mastery and 11.5 CH/ 11.5 AEU. Next course takes place November 9, 2024 from 9:00am - 4:30pm ET & November 10, 2024 from 9:00am - 2:30pm ET. Register Now for Medical Laser Safety Officer Course.

References:

1. Dennis  E. Decreasing airway fires. OR Nurse 2012. 2012;6(2):37–40. [VB]
2. Dhar  V, Young  K, Nouraei  SA  et al. Impact of oxygen concentration and laser power on occurrence of intraluminal fires during shared-airway surgery: an investigation. J Laryngol Otol. 2008;122(12):1335–1338 [IIIB]  [PubMed: 18577278]
3. American National Standards Institute Laser Institute of America. ANSI Z136. 32018. : American National Standard for Safe Use of Lasers in Health Care. Orlando, FL: Laser Institute of America; 2018. [IVC]
4. AST Standards of Practice for Laser Safety.Littleton, CO: Association of Surgical Technologists; 2019. [IVC]
5. Dudelzak  J, Goldberg  DJ. Laser safety. Curr Probl Dermatol. 2011;42:35–39 [VC]  [PubMed: 21865796]
6. Smalley  PJ. Laser safety: risks, hazards, and control measures. Laser Ther. 2011;20(2):95–106 [VB]  [PubMed: 24155518]
7. Stuermer  KJ, Ayachi  S, Gostian  AO, Beutner  D, Hüttenbrink  KB Hazard of CO₂laser-induced airway fire in laryngeal surgery: experimental data of contributing factors. Eur Arch Otorhinolaryngol. 2013;270(10):2701–2707. [IIIC]   [PubMed: 23636479]
8. Dhar  V, Young  K, Nouraei  SA  et al. Impact of oxygen concentration and laser power on occurrence of intraluminal fires during shared-airway surgery: an investigation. J Laryngol Otol. 2008;122(12):1335–1338 [IIIB]   [PubMed: 18577278]