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Preventing fires in the OR

Hospital Safety Insider, October 19, 2017

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While wildfires continue to rage in California, it’s important to remember that even a small flame can wreak havoc in an OR. According to The Joint Commission, surgical fires happen just as often as wrong site surgeries and often have fatal consequences. 

There are around 240 surgical fires each year, the majority of which are preventable. While these events are rare, providers can use planning and awareness to lower the risk from “rare” to “nearly impossible.” As extra incentive, remember that CMS and The Joint Commission have been cracking down on fire safety and life safety requirements.

For a fire to start, it needs an ignition source, fuel source, and oxidizer. In the OR, possible ignition sources include:

•    Fiber optic light sources
•    Electrosurgical units (ESU)
•    Lasers
•    High-speed drills producing sparks

Fuel sources can be:

•    Alcohol-based skin preparation agents
•    Towels
•    Gowns
•    Masks
•    Surgical drapes
•    Even the patients themselves

And potential oxidizers include supplemental gases like such as oxygen and nitrous oxide, although it should be remembered the oxygen in the air can be enough for a fire to start (otherwise, matches couldn’t be lit indoors).

Medical devices can also pose their own fire hazards. Last year, the Food and Drug Administration (FDA) released a report warning that mobile medical carts have been overheating, igniting, smoking, burning, or exploding. Similar to the Samsung Galaxy 8, the fires are caused by carts’ lithium batteries and are extremely hard to extinguish. In some cases, firefighters have had to bury medical carts to put out the flames.

Preventing fires requires active participation from the surgical team members, and healthcare organizations can help prevent surgical fires by:

•    Creating guidelines on minimizing oxygen concentration in the surgery area
•    Giving the team enough patient prep time so they can manage potential fuel sources (including the patient)
•    Impressing on all staff members the importance of controlling heat sources by following laser and ESU safety practices
•    Creating and testing OR fire response procedures
•    Reporting any instances of surgical fires to The Joint Commission, ECRI Institute, FDA, state agencies, and others to raise awareness and ultimately prevent the occurrence of future fires

For more information and resources to prevent surgical fires as well as other safe surgery resources, check out the Council on Surgical and Perioperative Safety. 

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