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Year : 2009  |  Volume : 75  |  Issue : 8  |  Page : 101--110

Minimum standard guidelines of care on requirements for setting up a laser room


Member, Dermatosurgery taskforce, IADVL, SkinCity, Post Graduate Institute of Dermatology and Lasers, Solapur, Maharashtra, India

Correspondence Address:
Niteen Dhepe
SkinCity, Post Graduate Institute of Dermatology and Lasers, Employment Chowk, Solapur, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires careful planning keeping in mind safety of both patient and operator, convenience of operating, and optimum handling of costly equipments. The facility should be designed to handle procedures under local anesthesia and sedation. Facilities, staff and equipment to handle any emergencies should be available. Location: A room in existing dermatology clinic can be adequately converted to a laser room. Dimensions of laser room, its door and patient's table should be such that it should facilitate easy movement of patient, machine trolley, operator and assistant in case of routine procedures and in emergency. Physician Qualification: Any dermatologist with MD or diploma in dermatology can do laser procedures, provided he/ she has acquired necessary skills by virtue of training, observing a competent dermatologist. Such training may be obtained during post graduation or later in specified workshops or courses under a competent dermatologist or at centre which routinely performs such procedures. Electricity and uninterrupted power supply: Laser equipments should be connected to stabilizer or UPS circuits only. Preferably an on line UPS as recommended by the laser company should be installed. Earthing of the equipment is essential to avoid damage to the equipment and electrical shocks to the operator. Sufficient power back up to complete the procedure if power is off midway, is essential. Air-conditioning: Laser machines should be operated in low ambient temperature, with low humidity and dust free environment for longer life of machines. Patient chair: A dental/cosmetic chair with adjustable task light is a suitable option for patient positioning. The chair should have the option to tilt head down or 'syncope position' to facilitate resuscitation of a patient in vaso-vagal shock. Maintenance: Annual maintenance contract (AMC) is essential after warranty period is over and is essential for insurance purposes. Mobile Laser Unit: Mobile laser units are of relevance in the Indian context to render laser facility available in smaller towns. A laser with fiber optic delivery system can be made mobile after consultation with supplier. However a laser with an articulated arm delivery cannot be made mobile. Proper packing with shock absorbing material is necessary during transportation. The area where lasers are to be moved to and operated should have appropriate facilities as mentioned above. Records: Patient's health declaration questionnaires, laser register are essential records. Digital photography before and at regular intervals after procedure is an essential record. Detailed informed consent in patients language for each procedure explaining nature of procedure, anesthesia used, and machine used, post operative down time should be signed by patient. Drugs, anesthesia and sterilization: An electrocautery machine to control bleeding, equipments for airway maintenance, other instruments for emergency resuscitation and an emergency drug tray are essential. Standard sterilization practices are adopted. For most of laser procedures topical anesthesia is sufficient. Safe laser use: Protocols of safe laser use to avoid burns or eye damage to patients or operator are adopted. Reflective surfaces like mirrors, reflective jewelleries are not allowed in laser room. Machine should always be on standby mode when not in direct use. It should be used by authorized operator only. Eye protection: Goggles of sufficient optical density (OD) intended to protect from specific laser wavelength are to be used by all persons in laser room. Patient is given either same goggle or laser opaque shield. For procedures around eyes or on eyelids, internal eye shield made of laser opaque material are to be used. Fire extinguisher complying with local authority fire rules should be available and staff should be trained to use that. Safety and emergency protocols: Protocols for certain situations like vasovagal attack, anaphylaxis, uncontrolled bleeding, fire, accidental eye exposure should be in place and staff should be trained for these situations.






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