Which treatments may only be carried out by physicians or by practice personnel directly instructed by them and which treatments are fully prohibited?
Treatments falling under O-NIRSA may only be carried out by persons holding a certificate of competence, or by physicians and practice personnel directly instructed by them (see general information). Certain treatments as well as techniques and procedures may only be carried out by physicians and practice personnel directly instructed by them. Certain techniques and procedures are also prohibited and cannot be carried out by anyone.
What does directly instructed practice personnel mean
Directly instructed practice personnel are persons employed by a physician and working under the physician’s direct control, supervision and responsibility. These persons do not need a certificate of competence. The physician bears full responsibility and must therefore also be present in the practice during the treatments.
If the directly instructed personnel are employed in a medical facility, the contracts between the medical facilities (hospital, etc.), physicians and practice personnel as well as the work planning must be structured so the medical personnel are always under the direct instruction, supervision and responsibility of the physicians who must be present on site.
Third parties who, for example, are renting premises in a medical practice or facility, but are working independently, do not count as directly instructed practice personnel. These persons may only carry out treatments under Article 5, para 1 O-NIRSA with a certificate of competence.
Supervision of practice personnel by physicians is not being observed:
- if the physicians are not present on site during the treatment, but can be reached via communication devices instead;
- if there are no employment contracts between physicians and practice personnel, but the cooperation is regulated in another way.
Treatments on eyelids or close to the eyes subject to proviso
Treatments on eyelids or close to the eyes (up to 10 mm) may only be performed by physicians or practice personnel directly instructed by them in accordance with O-NIRSA, Annex 2 Number 2.2. This applies to the following treatments:
a. removing permanent make-up;
b. removing tattoos or telangiectasia (couperose);
c. treating spider naevi and haemangioma.
Treatments of skin changes subject to proviso
Certain treatments of skin changes may only be carried out by physicians or practice personnel directly instructed by them in accordance with O-NIRSA, Annex 2 Number 2.1. These comprise the skin changes below. A description of these skin changes is included in the enforcement aid (see documents below).
a. actinic and seborrhoeic keratosis;
b. age spots;
c. angiomas/large haemangiomas (greater than 3 mm);
f. genital warts;
h. port-wine stains;
m. sebaceous gland hyperplasia;
n. varicose and spider veins;
Procedures and techniques subject to proviso
Certain procedures and techniques can only be carried out by physicians or practice personnel directly instructed by them in accordance with O-NIRSA, Annex 2 Number 2.3. These comprise the procedures and techniques below:
a. highly focused ultrasound;
b. ablative laser;
c. long-pulsed Nd:Yag laser;
d. photodynamic therapies combined with the application of phototoxic substances or medicaments;
e. laser lipolysis.
Prohibited use of certain treatments
Certain treatments are fully prohibited under O-NIRSA, Article 6. These comprise the treatments below:
a. removal of tattoos and permanent make-up by means of intense pulsed light (IPL);
b. removal of melanocytic naevi by means of a laser or IPL.
Last modification 13.10.2023