This post outlines the legal requirements as well as national recommendations for expert advice in cosmetic laser and IPL settings.

Health and Safety at Work Etc. Act

Laser and IPL treatments carried out in the UK, in a workplace with employees, fall within the scope of the Health and Safety at Work etc. Act 1974. This act is enforced by local councils.

This legislation requires appropriate systems of work, supervision and provision of training. National recommendations published by the BSI, MHRA, BMLA and SRP clearly define the standards for what is appropriate.

Systems of work should include Local Rules and treatment protocols. The Local Rules form part of an employer’s means of complying with the Health and Safety at Work Act, section 2(3). According to the MHRA, Local Rules should be produced for each installation, reflect safe working practices and relate to the day-to-day safety management of lasers, IPL systems and LEDs. They must be in place on-site and reviewed annually. The BMLA Essential Standards require a separate treatment protocol for each laser or IPL treatment. In particular, the protocol must address:

• contraindications;
• technique;
• obtaining patient/client consent prior to treatment;
• record keeping requirements and treatment process (step by step guidance);
• cleanliness and infection control within the treatment environment;
• pre-treatment tests;
• post-treatment care;
• recognition of treatment-related problems;
• procedure if anything goes wrong;
• permitted variation on machine variables.

The treatment protocol should be reviewed either when there is a change of treatments or if evidence comes to light that shows a change is in the clients’ interests.

Supervision must be performed by a suitably trained and knowledgeable individual. Laser safety supervision should be carried out by a certificated Laser Protection Adviser (LPA) who has demonstrable knowledge of safety requirements for cosmetic laser and IPL systems. Laser and IPL users must have access to safety advice from a certificated LPA, who is also responsible for writing and reviewing the Local Rules. Evidence of the LPA’s laser/IPL certification should be available for reference on site.

Clinical supervision is performed by an Expert Registered Healthcare Professional (ERHP). The EHRP should be registered with the General Medical Council, Health Professions Council, General Nursing Council or General Dental Council, as appropriate, and they must be able to demonstrate expertise in the area of treatment covered by the protocol. Treatment protocols must be traceable to the ERHP to confirm authorisation and validity along with evidence of the means by which the ERHP provides ongoing support and advice.

Training is required in:

• the laser or IPL system(s) in use
• the treatment(s) performed
• laser safety.

Laser safety must include a BMLA approved course covering the Core of Knowledge curriculum. Evidence of training attendance certificates should be held within the establishment, as well as evidence of continuing professional development.

The Management of Health and Safety at Work Regulations, which forms part of the Health and Safety at Work family of legislation, requires that the employer appoints “one or more competent persons to assist him in undertaking the measures he needs to take to comply with the requirements” who has “sufficient training and experience or knowledge and other qualities” to do this. In the context of laser and intense light treatments, this role is fulfilled by a certificated Laser Protection Adviser.

Control of Artificial Optical Radiation at Work Regulations

The Control of Artificial Optical Radiation at Work Regulations (AORD) provides strict exposure limits for employees who may be exposed to artificial optical radiations, such as those produced by lasers, IPLs and LEDs. These limits are adhered to through appropriate risk assessment and the requirements described in the above section.

The Health Protection Agency (now Public Health England) produced a non-binding guide to help with implementation of the regulations. The non-binding guide recommends the use of Local Rules where the risk assessment identifies a potential for exposure to hazardous level of optical radiation, as well as either employing expert in optical radiation safety management or appointing an external adviser.

Recommendations

The BMLA Essential Standards form the basic set of requirements and mirror the legal requirements found in the Independent Health Care Regulations (Northern Ireland), the Independent Health Care (Wales) Regulations and the Regulation of Care (Scotland) Act. As such, they are commonly used by local councils in England when determining the suitability of a business or investigation complaints.

Councils also look to businesses offering laser and IPL therapy to be able to demonstrate competencies using the Health Education England training recommendations. This lays out a curriculum of work against which laser practitioners have to demonstrate compliance at varying levels of complexity, dependent upon the treatment being carried out. It also requires that all employers must appoint or consult a certified LPA where Class 3B and Class 4 lasers or IPL systems are being used, including to deliver teaching in laser safety and set out safe systems of work.

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