2 Laser Safety Risks to Make You Think Twice

No one intended to partially blind a nine-year old during a routine laser procedure to remove a port-wine stain birthmark around the patient’s eye. But that’s exactly what happened, robbing a young child of her sight in one eye forever with a physician and staff nurse untrained in laser safety to blame. The cause: inadequate eye protection during the procedure.

Although the medical record noted the patient was protected with a corneal eye shield through the entire case, she was not, and her eye was exposed to the Alexandrite 755nm laser, which caused the structures of her eyeball to weld together.

This is one of countless laser injury cases laser safety expert Vangie Dennis, MSN, RN, CNOR, CMLSO, hears. She helped author AORN’s new stand-alone guideline for laser safety, which reflects periop-specific guidance backed by ANSI and OSHA, because laser safety is a federally regulated mandate.

Despite being a regulatory requirement, she says laser safety is NOT  adequate in many healthcare organizations, leaving patients and frontline staff to pay the price.

Two Unsafe Laser Practices and What’s at Stake

Dennis cites two major concerns on her laser safety radar:

1. Inadequate eye protection causing patient and staff vision loss.
   Evidence-based guidance noted in AORN’s laser safety guideline requires eye protection that is applicable to the specific wavelength and optical density of the laser in use, which must be worn in the nominal hazard zone. The guideline also states that the patient’s eyes and eyelids must be protected from injury using a method approved by the laser safety officer.
   
   “It’s not just a matter of following your facility policy,” Dennis says. “Too often policies don’t outline the right safety practices and don’t require a laser safety officer, instead relegating this role to the rep or rental contact, which can leave dangerous gaps in safety understanding.”
   
   For example, she is aware of certain laser equipment sales representatives who train perioperative teams not to wear eye protection during the duration of laser use and have been distributing a white paper to back these false safety claims that completely contradict AORN and OSHA guidance.
   
   “Too often people are taking the word of their sales rep, instead of investing time to learn the facts,” Dennis says.


2. Unsafe airway protection, risking surgical fire.
   Lasers represent an ignition source for surgical fire and fire risk assessment and mitigation strategies must be applied for laser-shared airway procedures. For example, the AORN laser safety guideline recommends using an FDA-approved, laser-retardant endotracheal tube during laser procedures involving the airway.
   
   Safety practices surrounding fire prevention are essential to understand clearly, she says. “With the extensive safety guidance available from multiple professional organizations, including AORN and the American Society of Anesthesiologists, there is no excuse for an airway fire.”
   
   Sadly, perioperative nurses are still working in unsafe laser use conditions and are often involved in surgical fire litigation as a result of patient injury or death.

How to Ensure Laser Safety

“Knowledge is definitely power when it comes to laser safety,” Dennis stresses. “Unfortunately, you don’t know what you don’t know, and facility leadership is often to blame for not setting correct safety practices.”

Staff nurses need to step up laser safety in their own ORs with these three steps, she advises:

Step 1: Practice situational laser safety awareness to be aware of and call out any laser safety risks immediately.

Step 2: Conduct a thorough laser safety risk assessment that is evidence-based and in line with the AORN laser safety guideline.

Step 3: Build your knowledge of laser safety standards, regulations, and practice guidelines.

Here’s where to start your laser safety education:

• Review AORN’s new Laser Safety guideline, which outlines specific risk mitigation strategies based on evidence, now available on eGuidelines Plus, available by subscription. It will be published in the 2022 publication, Guidelines for Perioperative Practice.
• Compare your facility’s laser safety policies and procedures against the AORN laser safety guideline.

Learn more from Dennis and colleague Patti Owens, BSN, RN, MHA, CNOR, CMLSO, on 2021 Translational AORN Laser Guidelines on Sunday, Aug. 8, 8 am at AORN Global Surgical Conference & Expo, in Orlando, Fla.