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Equipment for Aesthetic Dermatology Clinic

A aesthetic dermatology medical clinic differs from the traditional dermatology medical center in conditions of the requirement of a variety of equipment to perform various aesthetic strategies. Before, the only device associated with dermatology practice was a magnifying glass. It then progressed to equipment's such as Woods lamp fixture, electrocautery, radiofrequency, cryotherapy and phototherapy devices. Beyond these tools, the cosmetic dermatologists' armamentarium includes various basic and specific equipment's to carry out a multitude of dermatological treatments and cosmetology steps. (Package 1) In addition to the treatment equipment, picture documents devices are also essential. These devices record the results and changes for research and prognosis of the treatments and can actually document the percentile UV harm, wrinkle rating etc. The cosmetic clients (internet savvy) know about the equipment use in various methods and look for clinics offering facilities with the latest equipment and low downtime.

The cosmetic skin doctor not only must be modified about the latest equipment's but also needs to be familiar with its management and maintenance needs. Poor maintenance causes financial loss for the doctor and compromises on effectiveness and safe practices issues for the patient. This chapter gives a brief put together of equipment management and maintenance aspects which would permit the doctor to provide safe, effective treatments and preserve the financial aspects of his/ her practice optimally.

Box 1: Basic and Specialized equipment in a aesthetic clinic

Basic Equipment

Microdermabrader

Radiofrequency and cautery

Cryotherapy

Mesotherapy

Jet Peel or hydrafacial

Microcurrent

Electroporation

Dermatoscope and photography equipment ( complete in chapter 5)

Phototherapy Units

Specialised Equipment- LASERS and Light Systems

Intense Pulse Light

LASER Hair Decrease- Long Pulse Alexandrite, Long Pulsed ND YAG, Diode

Pigmentation- Q Switched ND YAG

Fractional and Ablative LASERS

Hair Repair- Low Level Lasers and lights

Skin Tightening up- LASERS and Radiofrequency, Micro needling Radiofrequency

Vitiligo and Psoriasis- Excimer light and LASER

Body contouring- Radiofrequency, cryolipolysis, ultrasound cavitation, low level laser remedy, etc.

BASIC REQUIREMENTS FOR EQUIPMENT MANAGEMENT

The basic requirement from any machine/ equipment is its durability and optimal use. This can be attained by effective equipment management strategies [1] (Box 2)

Box 2: Effective equipment management procedures

  • Equipment Purchase
  • Installation requirements (safe-keeping and space electronic supply, air-conditioner)
  • Standard Operating Protocols
  • Training of the staff
  • Quality control assessments (cleaning, protection devices, consumables, regular inspections)
  • Maintenance and servicing (Daily, Preventive, Annual )
  • Equipment/ Accessories modification

Equipment Purchase:

The following checklist should be considered during purchase of the gear. This can help to trouble shoot maintenance issues effectively.

  • Always obtain a qualified company or a qualified official dealer
  • Check with the seller for skilled technicians for unit installation and troubleshooting
  • Sign the maintenance agreement with the company (No machine is zero maintenance)
  • Establish the warranty period (details and time lines)
  • Note of the time frame of produce and the numerical code unique to each equipment.

Installation Requirements

Space and storage Requirements of the equipment and accessories should be taken into account prior to assembly.

Electrical relationships and stabilizers: This has been detailed in Chapter 60. Special sockets and high voltage breakers, stabilizers and UPS (uninterrupted power) should be provided.

Air conditioner: A lot of the Laser beam machines generate heat and require certain conditions to be taken care of while in operation. An air conditioned environment is recommended as it remains shut, relatively dust free and pays to for machine longevity.

Smoke evacuators Fragments of skin area, scalp and aerosols can harm LASER lenses or light based mostly equipment anticipated to physical interference with transmission. Smoke cigars evacuation systems enable you to reduce the plume debris and limit the unsafe results on the personnel, patients/clients and the laser beam equipment.

Standard Operating protocols (SOPs)

SOPs regarding consumption of the device are provided by the manufacturer. Indications and Specs are given in the operator manual and really should be adhered to. Based on the patient requirement, if adjustments are made in the SOPs, these should be noted and informed to all or any the staff.

Training of staff (machine operators or staff in charge of maintenance)

All the staff members in the cosmetic dermatology set up should be trained to check out the SOPs, understand the necessity and importance of equipment maintenance for the clean working of the medical clinic.

Quality control checks (cleaning, protection devices, consumables)

In addition to the daily cleaning; regular every week or fortnightly check of each machine, safety devices and consumables should be achieved. This helps to prevent crisis maintenance issues and financial losses.

Maintenance and servicing (Daily, Preventive, Annual)

A record should be retained of all prepared and unplanned maintenance and services, including any problems or improvements. The service deal records, contact details of service workers should be documented well.

Equipment/ Item modification

Any adjustment to the gear or accessories; or change in its operational utilization may have security implications associated with it. Hence, whenever any changes is performed, appropriate paperwork is compulsory. Standard accessories should be used.

STANDARDISED AND EFFECTIVE EQUIPMENT MANAGEMENT

A standardised form, including all the aspects complete above for equipment management should be placed with specific machines. A gentle/ hard backup of the format for everyone machines should be catalogued and help as a ready reckoner to the concerned staff. A basic outline of the proper execution has been provided in Field 3. The salient aspects for effective equipment management have been contained in Pack 4.

Box 3: Standard form for specific machines

Name of the machine

Indications

Standard requirements (usually provided by maker)

Storage features: Equipment/ Accessories

Space: Table attached/ Floor mounted

Electricity: Earthing/ UPS requirement

AC requirement

Consumables

Safety devices- Goggles, air conditioning devices, smoke cigars evacuators

Cleaning Techniques

Maintenance- Daily, Preventive, Total annual or extensive maintenance services ( AMC/ CMC)

Special tips do's and don't's

Installation date

Operator Training: Names/ Dates

Contact details for Maintenance services: Cellphone/ Mail id/ Website address/ Personnel

Warranty details: Equipment/ Accessories, along with datelines

Services Contract: AMC/ CMC, Renewal along with Dates

Service done: Times/ Done by whom/ Supervisory staff

Box 4: General Techniques for effective equipment management

  • Keep a standardised form with specific machines.
  • Train the staff to handle the equipment carefully
  • Understand the Operators manual
  • Take care of all the parts of machine.
  • Hand portions are the most important part. Place them in a defensive field or on the machine as instructed
  • Keep the list of the consumables
  • Keep all the machines protected and in a dust free environment
  • Contact technical employees for precautionary machine maintenance at regular intervals
  • Check for contraindication in case there is all clients

BASIC EQUIPMENT MAINTENANCE

The general ideas of basic equipment maintenance (according to the standardised form) has been defined in Desk 1. Modifications can be done based on individual machines and medical clinic requirements.

Table 1: Basic Equipment Management

Equipment

Crystal

Diamond- USG, Cleanser, head

Salt - cartridges

Microcurrent

Diamond Pro Lift

Radiofrequency /Cautery

Mesomate/Dr Injector

Injector MesoGun-Manual-Automatic

Jet M Machine

Indications

Exfoliation gently takes out the outermost inactive skin cell level for the epidermis.

Reduces pigmentation and tanning

Improves Acne scars

Reduces fine lines and wrinkles

Reduces pore size and years spots

Facial lift

Muscle lift

Body Contouring

Iontophoresis-Product penetration

Disencrustation- Deep cleansing

Dermatoses papulosa nigra (DPNs)

Warts

Skin tags

Moles

Seborrheic Keratosis

Granuloma pyogenicum

Xanthelesma

Rhinophyma

Dull skin

Irregular texture

Uneven pores and skin tone

Hair loss

Cellulite

Lymphatic drainage

Exfoliation

Infusion

Standard operating protocols

Available

Available

Available

Available

Available

Storage

-

-

-

Temperature:20 -600 C

Humidity< 95%

-

Space

Table mounted

Table mounted

Table mounted

Table mounted

Dr. . Injector has its own Trolley

Table attached or specially designed trolley

Electric/

UPS/ AC

Earthing +

UPS/ AC-

Earthing +

UPS/ AC-

Earthing +

UPS/ AC-

-

Earthing +

UPS/ AC-

Consumables

Hand piece with regards to the type of machine

Nozzles of two different sizes small for face and throat and big for the body parts

Aluminium oxide crystals

Two long metallic probes, one small probe with sponge for earthing, two collections of coloured wires, one metal roller, sticky pads and big pads.

Hand piece

Wire loop electrode and directed electrode

Disposable as well as reusable tips are available

Kinked wires might need replacement

Safety devices

Foot pedal

Air tubing

Triple nozzle handpiece

Safety goggles (during peel off infusion )

Vitamins

Cleaning

The jar needs to be cleared of all the crystals after every service and washed.

Hand piece must be cleansed with alcoholic beverages swab before use.

Tissue residue should be taken off the active electrode (Rf electric power ON) with a sterile moist gauze (water only)

No scalpel scissors or any razor-sharp objects should be utilized as it may lead to muscle adherence

Disinfection

All commercially available disinfectants enable you to disinfect the electrodes.

Electrodes should be immersed in fresh cidex solution. they must be washed and under plain tap water, dried and Placed in the offered box

Sterilisation

All non- throw-away hand items, cables, plugs and electrodes are autoclavable to 2500 F or 1210C.

Steam cleaning of electrodes must be achieved just before use.

Sterilize the safeguard with alcoholic beverages swab before the service

Regular cleaning of hands piece

Maintenance

Jar must be changed every fortnight for clean functioning of the machine

Spare hand pieces should always be available

Replace filtration and nozzle after each 15 bottles

Daily Maintenance:

Clean hand piece with liquor swabs or SPCL cleaning Solution.

Straighten the tubes.

AMC

Preventive maintenance should be achieved at an period of 1-2 months

Preventive machine maintenance at an period of 1-2 weeks.

The electrodes should be dipped in dilute H2O2 solution so that debris gets cleared,

before washing

AMC

Preventive machine maintenance should be at an period of six months.

Daily Maintenance

Clean the weapon exterior with spirit.

Do not allow soul to enter in the interiors.

Charge the Gun daily

AMC

Preventive machine maintenance should be at an period of six months.

AMC

Preventive machine maintenance should be at an interval of six months.

Special Tips: Do's and Don'ts

Do's- follow the instructions stated in the user manual

Don'ts - do not place anything on the machine

Don'ts- Coloured wires should always be tied up and placed on the machine you should definitely in use

Do's- The only way the radiosurgery can create injury is if the heat is permitted to accumulate in the cells to the stage where it can result in excessive dehydration and hence tissue destruction. Preventing accumulation of such high temperature is the basic goal of radiosurgery technique and hence you need to practice 10 mere seconds ON and 30 seconds OFF.

Don'ts - Do not Use any inflammable anesthetics or cleaning realtors.

Use the injector and needle that complies with the international and local standards.

-

SPECIALISED EQUIPMENT MAINTENANCE

Specialised equipment's such as Lasers, lamps, radiofrequency structured machines are actually an integral part of cosmetic clinics. Many of these equipment are expensive and have specific maintenance issues. Furthermore, the optical rays emitted by lasers, IPLs and LEDs has probably hazardous results on patients, clients and equipment users. There can be direct damage to eyes or pores and skin. A potential threat 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 beam machine), procedural (policies and practices implemented at the cosmetic clinic) and administrative (review by health section) control actions are had a need to prevent exposure to potential laser hazards. [2]

Effective equipment management procedures as outlined in Box 2 should be implemented for each and every of the specialised equipment in the medical clinic. The main facet of maintenance is simple prevention. This can be achieved through the next measures:

  • Routine inspection, of the laser beam system and the environment (Daily/ weekly inspections)
  • Periodic inspection and maintenance of optical components and critical subassemblies (Preventive and twelve-monthly maintenance bank checks)
  • Documentation and Record keeping

Few cases for daily/ weekly/ preventive bank checks for laser equipment are specified in Field 5 [1]

Box 5: Instances for daily/ every week/ preventive bank checks for laser equipment

Examples for daily investigations:

Check if the laser output terminates on release of feet/ hand switch

Check the device's positioning of the aiming beam with the therapeutic beam

Check device's filter systems/ methods for scratches or mud.

Check all system alarms and signals are working appropriately

Assess all device accessories including cables and connectors are clean and functioning.

Examples for weekly checks:

Inspect protective eyeball wear for lens scratches or basic damage

Check all protecting blinds, windows and doors, are dust free and functioning appropriately

Check that electric system cable connections/ UPS, alert lights are functioning correctly

Examples of annual/ preventive checks:

Electrical safety

Device calibration checks

Output measurements

Beam alignment

Shutter operation

Accuracy of timer

Filters

The general methods for secure and efficient laser beam equipment management are discussed in Field 6. The general ideas of specialised equipment maintenance (as per the standardised form) has been specified in Table 2. Modifications can be done based on specific machines and medical center requirements.

Box 6: General tips for secure and efficient laser equipment management

Laser Room (details in section 60)

  • Restrict accessibility to the area when the system is in use; put laser alert sign
  • Do not include any light reflecting items such as reflection,
  • Provide silicone mat flooring ( prevents destruction and losses in case of accidental street to redemption of hand parts, goggles, etc)

Services/ Maintenance checklist

  • Maintain a logbook of regular maintenance check and calibration
  • Maintain detailed information about service centre/ personnel
  • Check for engineers training license.
  • Calibration must be checked out by authorized employees with calibrated vitality meter.
  • Always look for calibration certificate when under AMC/ Maintenance
  • Deionized (DI) water is necessary for cooling in a few machines. Check levels 1-3 regular and change
  • Check fire safety measures
  • Check for Electromagnetic immunity and declaration compliance.
  • Check for suggested separation distances between portable and mobile RF marketing communications equipment and laser

Equipment Use

  • Check the power resource/ UPS before the machine is switched on.
  • If the machines need to be moved to a different room, get it done carefully and prevent jerky movements
  • Always place the tips or side pieces in the chosen box in order to avoid any accidental fall or damage to the same
  • Optical lenses, fibre optic cord, some hand pieces contain lasing medium are expensive, hence manage all equipment parts with care Never leave the machine in ready setting unattended
  • Practice use of hand switch approximately possible
  • Most laser displays have a touch screen. Be sure never to point on the display screen while firing the laser shot ( Can inadvertently happen with the ft. pedal)
  • In event of any crisis use the disaster shut -off knob
  • Use colourless gels for lasers
  • Use Skin area markers and colours for demarcating areas. Skin area markers should be preferably white or appropriate shade with respect to the laser absorption range if not they can become chromophores and cause burns
  • Cleanse and dry out the region to be lased thoroughly
  • Inspect the laser tip always before dealing with the patient. Usually do not use if harmed.
  • Make sure the correct eye wear is utilized (Different protective eyewear is indicated for different wavelengths)
  • Do not treat eyebrows eyelashes or other areas surrounding the eye orbit with Nd: YAG or Er: YAG lasers. The light emitted by these can cause serious vision damage or blindness. Use corneal shields especially in conditions of immediate touch lasers being found in the orbital area.

Gas based and pulse dye lasers (Example- Excimer, Pulse dye lasers)

  • Switch ON everyday
  • Cleaning of palm piece with alcoholic beverages swabs.
  • Gas bottles used as consumables are incredibly expensive
  • Mirrors needs to be washed by technicians every three months.
  • Calibration of voltages is very important.
  • Dye must be replaced after 50000 shots

Body shaping and contouring machines:

  • All hand portions need to be cleaned daily
  • Better to use specific oils or gels, otherwise ultra-sonography gel can be used; may be glycerine based.
  • The emitted tones should be perfect

Phototherapy units

  • Check lamp vitality on a monthly basis and calibrate if needed
  • Clean admirers every quarterly

Table 2: Standard concepts of specialised equipment maintenance ( separate doc- horizontal graph)

CONCLUSION

Equipment management and maintenance is an integral part of the cosmetic practice arranged- up. Specialised equipment such as lasers and radiofrequency based mostly devices are expensive and have specific maintenance issues. In addition to the financial implications for the practice, the safeness and efficiency of the treatments provided by the medical doctor are chiefly reliant on well managed equipment.

SUMMARY

A cosmetic dermatology center differs from the original dermatology medical center in terms of the necessity of a wide range of equipment to perform various aesthetic procedures. It is a good practice to hire equipment management and maintenance steps. The effective equipment management methods include checklists and techniques for purchase, set up, growing standard operating protocols, staff training, quality control assessments, maintenance and servicing (daily, precautionary, gross annual ) and adjustments in equipment/ accessories. Good equipment management and maintenance techniques have healthy financial implications for the practice. It guarantees optimal usage and endurance of the device life, along with effective and safe treatments for the patients/ clients.

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