By Richard Parker, MBA, CHFM, CLSS-HC, FASHE, FACHE
How well does your organization prepare for a surgical fire in or on a patient? The oxygen rich environment, flammable preps, combustibles, and sources of ignition all represent specific risks in an operating room that contribute to the potential for a fire. Processes in the OR are unique and warrant a specific plan to address them and the risk they create.
CMS references the National Fire Protection Association’s (NFPA) Health Care Facility Code (HCFC), NFPA 99: 2012 edition. Chapter 15 of the HCFC titled Features of Fire Protection, includes a section focused on this issue:
15.13 Fire Loss Prevention in Operating Rooms
- Hazard Assessment
- Fire Prevention Procedures
- Germicides and Antiseptics
- Emergency Procedures
- Orientation and Training
ACHC recommends periodically reviewing each of the elements in this resource with the goal of developing an effective surgical fire response plan. This will keep your process top of mind, current and relevant to patient and staff safety should this type of fire occur. As always when planning for an emergency, best practice dictates starting with a risk assessment.
Evaluate the hazards
Your risk assessment must include hazards such as electricity, the operation of surgical equipment, and other conditions associated with the nature of the surgical environment, for example the presence of accelerants and flammable materials and the unique consideration that the fire may be in or on the patient.
Another element to consider when performing the risk assessment is a review of the different types of fire extinguishers. Your risk assessment will have identified the hazards present or anticipated in the environment. When you consider that the fire may be in or on a patient, that is a factor that adds a different consideration as this would directly impact the selection of a fire extinguisher. An ABC extinguisher uses a dry chemical to extinguish a fire but using this on a patient will cause other troubling issues impacting their health. Many organizations will install either a water mist or carbon dioxide (CO2) extinguisher in the procedure room, and an ABC extinguisher accessible in the space outside the procedure rooms.
Recognition that hazards change because of new equipment technology, changes in personnel and different processes demand that the risk assessment is periodically reviewed to identify those changes.
Consider changing conditions
The HCFC section on Fire Loss Prevention in Operating Rooms is the most detailed in the chapter. The requirements related to germicides and antiseptics are explicit, in part, because these materials are a clear contributor to surgical fires and those in use may change over time. Liquid antiseptics or germicides would be identified in your risk assessment. And don’t forget to address alcohol-based hand sanitizers (including those dispensed as aerosols).
Procedures are expected to prevent pooling of flammable liquids and to remove solution-soaked materials from the OR prior to draping.
This section also includes a description of the “time out” process to verify that:
- The application site for germicides and antiseptics is dry prior to draping.
- Pooling has not occurred or has been remedied.
- All solution-soaked materials have been removed from the OR prior to draping or the use of electrosurgery, laser or cautery.
The risk assessment should consider the relationship among these solutions, other combustibles such as drapes, and the ignition sources such as the use of electrosurgery or lasers.
Build your emergency procedure
Your fire response plan for an operating room fire must include:
- Alarm activation.
- Equipment shutdown procedures.
- Provisions for control of emergencies that could occur.
The emergency procedures specific to surgery must also include controlling chemical spills and extinguishing equipment, clothing or drapery fires.
Are you conducting meaningful and relevant training and drills?
The fire response plan and procedures should be documented in writing, then observed and evaluated periodically. This activity begins with orientation and training for all relevant personnel.
New personnel are required to be taught general safety and specific safety procedures for the OR environment. Routine education for existing staff members should be planned and implemented.
Part of the training should include the proper use of the different fire extinguishers.
- Water mist is effective on Class A fires.
- CO2 is effective on Class B and Class C fires.
- Dry chemical (ABC Powder) is effective on Class A, Class B and Class C fires.
NFPA 99-2012 requires at least an annual fire exit drill. This is separate from the general hospital drills and is based on the surgical fire response plan. Fire drills simulate emergency fire conditions and are a training tool to practice the assigned roles for each member of the OR team. The annual fire drill is not expected to be performed with an actual patient.
Post training, as drills are performed, take a critical approach to identify areas to improve. At minimum, your procedures must be reviewed annually and updated as indicated by changes in the environment or through analysis of drills. On a monthly basis, any actual incidents must be reviewed.
Surgical case fires represent high risk for patients. Using NFPA 99-2012 as a resource for building your plans helps to mitigate risks to your patients and staff with proactive safety in mind.
– Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs.
