MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- A recent Public Health audit of Madigan's laser safety program resulted in it being lauded as the best of its kind across Army Medicine.

"The auditor said this is the model program; this is what other military treatment facilities should be doing," said Capt. Eva Eck, Madigan's lead laser safety officer. The audit team cited the organization, experience and education of all of the hospital's laser safety officers as standing out from their peers.

Eck said the empowerment of the laser safety officers also stood out.

"They have a strong voice -- a lot of these clinic laser officers will step up; they know if something is not right, they will stop the procedure," she said.

Altogether, nine Madigan sections use lasers; the program is also supported by clinical engineers and certified laser repair technicians. Lasers are used in procedures including skin resurfacing, kidney stone treatments, eye surgeries, deep tissue treatment and dental work.

Although commonly used, risks associated with lasers can include eye injuries -- to both patients and staff--and skin injuries such as burns or cuts. These risks mean that Madigan enacts rigorous safety precautions every time a laser is used.

"If you don't have the proper eyewear, it can damage your eyes for life … the rule of thumb is, no matter where it bounces off your eye, you need to have the proper eyewear on," said Patty Field, a registered nurse and laser safety officer for the Ear, Nose and Throat Service here.

The unique wavelengths of different lasers require different eyewear protection, so staff need to know which eyewear to use, said Leah Ashe-Everest, a licensed practical nurse who works in the ENT's laser room. Patients receive specialized eyewear as well to ensure they are always protected in laser procedures.

In fact, Field developed standard operating procedures and checklists to ensure that each laser procedure follows the same stringent levels of safety precautions, such as ensuring saline is on hand, fire extinguishers are nearby, and the door is locked to the laser room to minimize disturbances.

Given the extra thermal energy created by lasers, Madigan's operating room also places wet towels around the area being lasered to reduce risk even further, said Stephen Frederick, the education coordinator for the Department of Anesthesia and Operative Services. He's a perioperative nurse by trade who's worked in laser safety for 25 years.

If providers work on patients' airways with lasers, they adhere to additional safety measures such as using specific tubes and keeping oxygen levels to a minimum.

"Our anesthesia providers are well-versed in safety measures too because we do initial and we do annual safety training too for the whole department," said Frederick.

The laser safety program follows the guidelines for safe use of lasers in healthcare set by the American National Standard Institute.

"The standards say that your laser operators must be trained in the basic biophysics of laser energy, laser-tissue interactions, and the operational characteristics of the laser you're using, but they don't tell you specifically how to do that," said Frederick, who often fields questions from other treatment facilities about the safety program here.

He opted to create an eight-hour course for all laser operators, who must also be observed by him setting up laser procedures three times before they can run lasers on their own. In addition, his department has a dedicated laser operator to minimize the chance of error in laser procedures.

"It takes the support of leadership to want to take this time and resources to do that," said Frederick. "They're invested in overall patient and staff safety; it's a shared mental model."
Field also ensures that all staff and providers who use the ENT laser room are certified to safely do so.

"Madigan as a whole has come out on the forefront because we really ensure that people are trained and know what they're doing as far as running a safe laser room. I would say that's a huge safety best practice," she said.

This intense focus on safe laser use benefits both the staff using them and the patients being treated.

"They're in the safest hands possible with the staff here at Madigan," said Eck.