Equipment for Cosmetic Dermatology Clinic

Equipment for Cosmetic Dermatology ClinicA cosmetic dermatology clinic differs from the handed-down dermatology clinic in terms of the emergency of a wide range of equipment to work out various aesthetic procedures. In the past, the only instrument associated with dermatology practice was a magnifying glass. It then progressed to equipments such as Woods lamp, electrocautery, radiofrequency, cryotherapy and phototherapy units. Beyond these tools, the cosmetic dermatologists armamentarium includes various basic and specialized equipments to carry out a multitude of dermatological treatments and cosmetology procedures. (Box 1) In addition to the treatment equipment, photo keep devices argon as well as essential. These devices record the results and changes for analysis and prognosis of the treatments and can actu in all(prenominal)y document the percentile UV damage, wrinkle score etc. The cosmetic clients (internet savvy) argon aware of the equipment role in various procedure s and check for clinics offering facilities with the latest equipment and low downtime.The cosmetic dermatologist not only requisites to be updated about the latest equipments but should also be aware of its focussing and sustainment needs. Poor alimentation leads to financial losses for the physician and compromises on efficacy and safety issues for the patient. This chapter gives a brief compend of equipment instruction and maintenance aspects which would enable the physician to provide safe, legal treatments and sustain the financial aspects of his/ her practice optimally.Box 1 Basic and change equipment in a cosmetic clinicBasic EquipmentMicrodermabraderRadiofrequency and cauteryCryotherapyMesotherapyJet Peel or hydrafacialMicrocurrentElectroporationDermatoscope and photography equipment ( exact in chapter 5)Phototherapy UnitsSpecialised Equipment- LASERS and Light SystemsIntense quiver LightLASER Hair Reduction- Long Pulse Alexandrite, Long Pulsed ND YAG, DiodePigmen tation- Q Switched ND YAGFractional and Ablative LASERSHair Restoration- Low Level Lasers and lights undress Tightening- LASERS and Radiofrequency, Micro needling RadiofrequencyVitiligo and Psoriasis- Excimer lamp and LASERBody contouring- Radiofrequency, cryolipolysis, ultrasound cavitation, low level optical maser therapy,etc.BASIC REQUIREMENTS FOR EQUIPMENT MANAGEMENTThe basic requirement from any machine/ equipment is its longevity and optimal usage. This can be achieved by effective equipment management procedures 1 (Box 2)Box 2 Effective equipment management proceduresEquipment PurchaseInstallation requirements (storage and space electrical supply, air-conditioner) pattern run Protocolshomework of the staffQuality control checks (cleaning, safety devices, consumables, regular inspections)Maintenance and servicing ( periodic, Preventive, Annual )Equipment/ Accessories fittingEquipment PurchaseThe following checklist should be kept in mind during purchase of the equipment. T his helps to trouble shoot maintenance issues effectively. eer buy from a certified company or a certified official bargainer declare with the dealer for skilled technicians for installation and troubleshootingSign the maintenance contract with the company (No machine is zero maintenance)Establish the warranty period ( detail and time lines) honour of the date of manufacture and the numerical code unique to each equipment.Installation RequirementsSpace and storage Requirements of the equipment and accessories should be taken into account prior to installation.Electrical connections and stabilizers This has been detailed in Chapter 60. Special sockets and high voltage breakers, stabilizers and UPS (uninterrupted role supply) should be provided.Air conditioner Most of the LASER machines generate hotness and require certain temperatures to be well-kept while in operation. An air conditioned environment is preferred as it remains closed, relatively dust free and is designful for mach ine longevity.Smoke evacuators Fragments of skin, sensory hair and aerosols can damage LASER lenses or light based equipment due to physical interference with transmission. Smoke evacuation carcasss may be used to curve the plume debris and limit the harmful effects on the staff, patients/clients and the laser equipment.Standard Operating protocols (SOPs)SOPs regarding usage of the machine are provided by the manufacturer. Indications and Specifications are provided in the operator manual and should be adhered to. Based on the patient requirement, if modifications are made in the SOPs, these should be documented and informed to all the staff.Training of staff (machine operators or staff responsible for maintenance)All the staff members in the cosmetic dermatology set up should be trained to follow the SOPs, understand the need and importance of equipment maintenance for the smooth functioning of the clinic.Quality control checks (cleaning, safety devices, consumables)In addition to the daily cleaning regular each week or semiweekly check of each machine, safety devices and consumables should be done. This helps to prevent emergency maintenance issues and financial losses.Maintenance and servicing (Daily, Preventive, Annual)A record should be maintained of all planned and unplanned maintenance and services, including any lines or modifications. The service contract records, contact details of service personnel should be documented well.Equipment/ Accessory modificationAny modification to the equipment or accessories or change in its operational usage may have a bun in the oven safety implications associated with it. Hence, whenever any modification is done, appropriate documentation is mandatory. Standard accessories should be used.STANDARDISED AND EFFECTIVE EQUIPMENT MANAGEMENTA standardised form, including all the aspects detailed above for equipment management should be kept with item-by-item machines. A soft/ hard copy of this format for all machin es should be catalogued and serve as a ready reckoner to the concerned staff. A basic outline of the form has been provided in Box 3. The salient aspects for effective equipment management have been included in Box 4.Box 3 Standard form for individual machinesName of the machineIndicationsStandard specifications (usually provided by manufacturer)Storage specifications Equipment/ AccessoriesSpace Table mount/ Floor mountedElectricity hide out/ UPS requirementAC requirementConsumablesSafety devices- Goggles, cooling devices, smoke evacuatorsCleaning TechniquesMaintenance- Daily, Preventive, Annual or comprehensive maintenance services ( AMC/ CMC)Special tips dos and dontsInstallation dateOperator Training Names/ DatesContact details for Maintenance services Phone/ Mail id/ Website address/ PersonnelWarranty details Equipment/ Accessories, along with datelinesServices Contract AMC/ CMC, Renewal along with DatesService done Dates/ fag oute by whom/ Supervisory staffBox 4 General Tips for effective equipment management hang on a standardised form with individual machines.Train the staff to handle the equipment carefullyUnderstand the Operators manualTake care of all the parts of machine.Hand pieces are the most important part. Place them in a preventive box or on the machine as instructedKeep a check list of the consumablesKeep all the machines covered and in a dust free environmentContact technical personnel for rubber machine maintenance at regular intervals baulk for contraindication in case of all clientsBASIC EQUIPMENT MAINTENANCEThe general principles of basic equipment maintenance (as per the standardised form) has been outlined in Table 1. Modifications can be done based on individual machines and clinic requirements.Table 1 Basic Equipment ManagementEquipmentCrystalDiamond- USG, Cleanser, head season cartridgesMicrocurrentDiamond Pro LiftRadiofrequency /CauteryMesomate/Dr InjectorInjector MesoGun-Manual-AutomaticJet M MachineIndicationsExfoliation ge ntly removes the outermost dead skin cell layer for the epidermis.Reduces pigmentation and whippingImproves Acne scarsReduces fine lines and wrinklesReduces pore size and age spotsFacial liftMuscle liftBody ContouringIontophoresis-Product penetrationDisencrustation- Deep cleansingDermatoses papulosa nigra (DPNs)Warts bark tagsMolesSeborrheic KeratosisGranuloma pyogenicumXanthelesmaRhinophymaDull skinIrregular textureUneven skin toneHair lossCelluliteLymphatic drainageExfoliationInfusionStandard operating protocolsAvailableAvailableAvailableAvailableAvailableStorageTemperature20 -600 CHumiditySpaceTable mountedTable mountedTable mountedTable mountedDr. .Injector has its own TrolleyTable mounted or specially designed trolleyElectric/UPS/ ACEarthing +UPS/ AC-Earthing +UPS/ AC-Earthing +UPS/ AC-Earthing +UPS/ AC-ConsumablesHand piece depending on the type of machineNozzles of two different sizes small for face and neck and big for the organic structure partsAluminium oxide crystalsTwo long metal probes, one small probe with sponge for earthing , two sets of coloured wires, one metal roller, steaming pads and big pads.Hand pieceWire loop electrode and pointed electrodeDisposable as well as reusable tips are availableKinked wires may need refillingSafety devicesFoot pedalAir tubingTriple nozzle handpieceSafety goggles (during peel infusion )VitaminsCleaningThe jar has to be light of all the crystals after every service and cleaned.Hand piece needs to be cleansed with alcohol swab before use.Tissue residue should be remove from the active electrode (Rf power ON) with a sterile moist gauze (water only)No scalpel scissors or any sharp objects should be used as it may lead to tissue paper adherenceDisinfectionAll commercially available disinfectants may be used to disinfect the electrodes.Electrodes should be immersed in fresh cidex solution .then they essential be washed and under tap water , dried and Placed in the supplied boxSterilisationAll non- disposable ha nd pieces, cables, plugs and electrodes are autoclavable to 2500 F or 1210C.Steam cleaning of electrodes must be done just before use.Sterilize the guard with alcohol swab prior to the service uninterrupted cleaning of hand pieceMaintenanceJar needs to be replaced every fortnight for smooth functioning of the machineSpare hand pieces should endlessly be availableReplace filter and nozzle after every 15 bottlesDaily MaintenanceClean hand piece with alcohol swabs or SPCL cleaning Solution.Straighten the tubes.AMCPreventive maintenance should be done at an interval of 1-2 monthsPreventive machine maintenance at an interval of 1-2 months.The electrodes should be dip in dilute H2O2 solution so that debris gets cleared,before washingAMCPreventive machine maintenance should be at an interval of 6 months.Daily MaintenanceClean the gun exterior with spirit.Do not allow spirit to enter the interiors.Charge the Gun dailyAMCPreventive machine maintenance should be at an interval of 6 months.A MCPreventive machine maintenance should be at an interval of 6 months.Special Tips Dos and DontsDos- follow the instructions mentioned in the user manualDonts do not place anything on the machineDonts- Coloured wires should unendingly be tied up and placed on the machine when not in useDos- The only way the radiosurgery can create tissue damage is if the heat is allowed to accumulate in the tissue to the point where it can lead to excessive dehydration and hence tissue destruction. Preventing accumulation of such heat is the basic objective of radiosurgery technique and hence one should practice 10 seconds ON and 30 seconds OFF.Donts Do not utilize any flammable anesthetics or cleaning agents.Use the injector and needle that meets the international and domestic standards.SPECIALISED EQUIPMENT MAINTENANCESpecialised equipments such as Lasers, lights, radiofrequency based machines are nowadays an integral part of cosmetic clinics. Most of these equipment are expensive and have s pecific maintenance issues. In addition, the optical radiation emitted by lasers, IPLs and LEDs has potentially gaga effects on patients, clients and equipment users. There can be direct damage to eyes or skin. A potential risk of fires or explosions from lasers igniting gases or fabrics and the problem of smoke inhalation exist. Engineering (in- built safety measures provided within the laser machine), procedural (policies and practices followed at the cosmetic clinic) and administrative (review by health department) control measures are needed to prevent exposure to potential laser hazards. 2Effective equipment management procedures as outlined in Box 2 should be followed for each of the specialise equipment in the clinic. The most important aspect of maintenance is simple prevention. This can be achieved through the following measuresRoutine inspection, of the laser system and the surroundings (Daily/ weekly checks)Periodic inspection and maintenance of optical components and c ritical subassemblies (Preventive and annual maintenance checks)Documentation and Record keepingFew examples for daily/ weekly/ preventive checks for laser equipment are outlined in Box 5 1Box 5 Examples for daily/ weekly/ preventive checks for laser equipmentExamples for daily checksCheck whether the laser getup terminates on release of foot/ hand switchCheck the devices junction of the aiming beam with the therapeutic beamCheck devices filters/ tips for scratches or dirt.Check all system alarms and lights are operating appropriatelyAssess all device accessories including cables and connectors are clean and functioning.Examples for weekly checksInspect protective eye wear for lens scratches or general damageCheck all protective blinds, windows and doors, are dust free and functioning appropriatelyCheck that electrical system connections/ UPS, sample lights are functioning correctlyExamples of annual/ preventive checksElectrical safetyDevice calibration checksOutput measurementsB eam alignmentShutter operationAccuracy of timerFiltersThe general tips for effective and safe laser equipment management are outlined in Box 6. The general principles of work equipment maintenance (as per the standardised form) has been outlined in Table 2. Modifications can be done based on individual machines and clinic requirements.Box 6 General tips for effective and safe laser equipment managementLaser Room (details in chapter 60)Restrict entry to the room when the system is in use put laser warning signDo not include any light reflecting objects such as mirror,Provide rubber mat flooring ( prevents damage and losses in case of accidental fall of hand pieces, goggles, etc)Services/ Maintenance checklistMaintain a logbook of regular maintenance check and calibrationMaintain detailed breeding about service centre/ personnelCheck for engineers training certificate.Calibration must be checked by authorized personnel with calibrated power meter.Always check for calibration certifi cate when under AMC/ MaintenanceDeionized (DI) water is needed for cooling in some machines. Check levels 1-3 monthly and changeCheck fire safety measuresCheck for Electromagnetic immunity and declaration compliance.Check for recommended separation distances between portable and mobile RF communications equipment and laserEquipment UseCheck the power supply/ UPS before the machine is switched on.If the machines need to be moved to a different room, do it carefully and avoid jerky movementsAlways place the tips or hand pieces in the designated box so as to avoid any accidental fall or damage to the same optic lenses, fibre optic cord, some hand pieces contain lasing medium are expensive, hence handle all equipment parts with care Never leave the system in ready mode unattendedPractice use of hand switch as much as possibleMost laser screens have a touch screen. Be sure not to point on the screen while firing the laser shot ( Can inadvertently rule with the foot pedal)In event of any emergency use the emergency shut off knobUse colourless gels for lasersUse Skin markers and colours for demarcating areas. Skin markers should be preferably white or appropriate colour depending on the laser absorption spectrum or else they can act as chromophores and military campaign burnsCleanse and dry the area to be lased thoroughlyInspect the laser tip always before treating the patient. Do not use if damaged. crystallize sure the correct eye wear is used (Different protective eyewear is indicated for different wavelengths)Do not treat eyebrows eyelashes or other areas surrounding the eye welkin with Nd YAG or Er YAG lasers. The light emitted by these can cause serious eye damage or blindness. Use corneal shields especially in cases of direct touch lasers being used in the orbital area.Gas based and pulse dye lasers (Example- Excimer, Pulse dye lasers)Switch ON universalCleaning of hand piece with alcohol swabs.Gas bottles used as consumables are very expensiveMirrors nee ds to be cleaned by engineers every 3 months.Calibration of voltages is very important.Dye needs to be replaced after 50000 shotsBody shaping and contouring machinesAll hand pieces need to be cleaned dailyBetter to use specific oils or gels, otherwise ultra-sonography gel can be used may be glycerine based.The emitted sounds should be perfectPhototherapy unitsCheck lamp power every month and calibrate if neededClean fans every quarterlyTable 2 General principles of specialised equipment maintenance ( separate doc- horizontal chart)CONCLUSIONEquipment management and maintenance is an integral part of the cosmetic practice set- up. Specialised equipment such as lasers and radiofrequency based devices are expensive and have specific maintenance issues. In addition to the financial implications for the practice, the safety and efficacy of the treatments provided by the physician are chiefly dependent on well managed equipment.SUMMARYA cosmetic dermatology clinic differs from the traditi onal dermatology clinic in terms of the requirement of a wide range of equipment to perform various aesthetic procedures. It is a good practice to employ equipment management and maintenance measures. The effective equipment management procedures include checklists and processes for purchase, installation, developing standard operating protocols, staff training, quality control checks, maintenance and servicing (daily, preventive, annual ) and modifications in equipment/ accessories. Good equipment management and maintenance practices have healthy financial implications for the practice. It assures optimal usage and longevity of the machine life, along with safe and effective treatments for the patients/ clients.