Medical Laser Safety Guidelines for Hospitals and Clinics

The main hazards of medical lasers

The eye is the most vulnerable organ. Depending on wavelength, the cornea, lens or retina absorbs the beam, and a reflection from a shiny instrument can be as harmful as the direct beam. Visible and near-infrared beams reach the retina, while far-infrared beams such as the 10.6 µm CO₂ laser are absorbed at the surface of the eye. Skin burns are the second hazard, and the beam can also ignite drapes, alcohol-based preparations, endotracheal tubes and anaesthetic gases.

The fourth hazard is the plume: smoke and particles released when tissue is vaporised, which can irritate the airway and carry biological material. Add electrical hazards and the risk of laser damage to patients through misuse, and the case for a formal programme is clear.

Laser classes and what they mean

The international standard IEC 60825-1 classifies lasers by the hazard they present, from Class 1, which is safe under normal use, to Class 4, which can cause serious eye and skin injury and is a fire risk. Most surgical lasers are Class 4. Some ophthalmic lasers are lower in class, but the physician protection filter and the controlled treatment area still matter. For manufacturer data, check the classification on each product page, for example the CLASSIC 514 retinal laser is listed as Class 4 and the CITO 532 as Class 3B.

A short explanation of each class is in our article on laser classes explained, and the standards behind them in IEC 60825 laser safety standards. Equipment safety for surgical lasers is also covered by IEC 60601-2-22, so ask suppliers how their system relates to it.

Engineering, administrative and personal controls

Think in layers. Engineering controls come first: a key switch, an emergency stop, a clear ready or standby state, foot-switch protection, beam enclosures, and built-in filters in the microscope or slit lamp. Administrative controls follow: a controlled area with warning signs, a log of use, written procedures, key control and training for all users.

Personal protective equipment is the last layer. Eyewear must match the wavelength and optical density of the laser in use, and it should be labelled and kept in the room. See laser safety eyewear for how to choose it. Protect the patient too: wet drapes or swabs near the field, protective covers for the eyes, and care with flammable preparations.

• Key switch, standby mode and emergency stop
• Controlled area, signs and door interlock where fitted
• Eyewear matched to wavelength and optical density
• Wet drapes and fire precautions near the field
• Named responsible person and written procedures

Plume evacuation and fire prevention in the operating room

Smoke should be removed at the source. A dedicated evacuator with a multi-stage filter and a quiet continuous flow serves HF, ultrasound and laser surgery. The ATMOS MEDAP FUMOVAC 700 delivers a flow of 700 l/min with a four-stage filter, according to the manufacturer. Read more in surgical laser plume evacuation.

Fire prevention matters most in airway work, where oxygen enrichment, tubes and a laser can combine to ignite. The principles are in our article on airway fire prevention. Communication between surgeon and anaesthetist before the beam is activated is the single most effective measure.

Responsibilities, training and support

Every facility that uses class 3B or 4 lasers should appoint a responsible person, usually called a laser safety officer. Their duties are described in the laser safety officer role. They maintain procedures, check eyewear, supervise training and investigate incidents. Confirm what DHA, DOH or MOHAP expects of your facility.

When buying a laser, ask the supplier about the user training, the technical file, and the service plan, because maintenance affects safety. Beckfinity distributes A.R.C. Laser systems, and its specialists can advise on laser safety features of the A.R.C. range when you plan a new service.