Preventing Surgical Fires in Operating Rooms

Darren Osleger

Imagine waking up in a post-anesthesia care unit (PACU) after you just went under for a normal, routine surgery only to be told that a fire occurred while you were under anesthesia.

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Surgical fires are just as bad as they sound. Imagine waking up in a post-anesthesia care unit (PACU) after you just went under for a normal, routine surgery only to be told that a fire occurred while you were under anesthesia. While this sounds like something out of a movie, the dangers are real. An estimated 90 to 100 surgical fires occur throughout the United States per year, with an average of two surgical fires occurring per week.

Although surgical fires are serious events, they are preventable and if they happen surgical teams need to be prepared. In fact, the NFPA 99 Health Care Facilities Code includes guidelines for training all operating room (OR) personnel in the prevention of surgical fires. Additionally, CMS and other health care accreditation organizations reference NFPA 99 2012 Edition.

For example, The Joint Commission Environment of Care (EC) Standard 02.03.01, Element of Performance (EP) 11 requires that “periodic evaluations, as determined by the [organization], are made of potential fire hazards that could be encountered during surgical procedures. Written fire prevention and response procedures, including safety precautions related to the use of flammable germicides or antiseptics, are established.” Also effective January 1, 2023, The Joint Commission EC.02.03.03, EP 7 requires annual fire exit drills for operating rooms/surgical suites to “involve applicable staff and licensed practitioners and focuses on prevention as well as simulated extinguishment and evacuation.”

Surgical Fire Risk Assessments

Before beginning a procedure and prior to a single incision, the surgical team should conduct a surgical fire risk assessment (FRA). FRAs help identify critical risk factors (i.e., heat oxygen and fuel) and can easily be incorporated into routine processes already in place for identifying other perioperative assessments and concerns. For example, after a team has verified the correct surgical site, patient identification and allergies, the surgical FRA will assess the specific risk factors and include a scoring mechanism to identify the surgery’s fire risk as high, medium or low. The scoring is an important tool to initiate open communication between the team and ensure that proper fire prevention procedures and risk mitigation strategies are in place.

Assessing Three Critical Elements: Heat, Oxygen and Fuel

Heat. Surgical energy is the ignition source for most surgical fires in or on the patient. The most common form of surgical energy is monopolar radiofrequency energy, also known as the “Bovie.” The Bovie converts electromagnetic energy into thermal energy, and it is the heating of tissue or the energy device itself that serves as the ignition source for the fire. Devices like fiberoptic light sources, lasers and high-speed burrs are other heat factors that could help ignite a fire. Hospitals need to provide proper education to all staff on when to use such devices and the hazards associated with each device.

Oxygen. How does oxygen relate to surgical fires? Oxygen can help enhance a fire, making it burn faster, stronger, bigger and brighter. During almost all surgeries, the anesthesia provider administers oxygen to the patient. How they deliver that oxygen is very important. Open delivery of oxygen poses a bigger threat to the patient than a closed system (e.g., patient being intubated). Certain risk reduction strategies can be used to limit the potential for oxygen-enriched atmospheres as well as pooling or “tenting” of oxygen in and around the patient.

Fuel. Controlling the heat source and monitoring how oxygen is admitted are easier steps to control. But fuel is all around us. Anything can be a fuel source, from the surgical drapes and prep solution applied on the patient’s skin to gauze pads and surgical towels. Ensuring that the prep solution is fully dried per manufacturer guidelines and being aware of fuel source proximity can dramatically help reduce the threat of fire occurrences.

Surgical Fire Training and Education

Hospitals and surgery centers need to invest time in education and training to help ensure that staff, surgeons and anesthesia providers are prepared to handle a surgical fire. Facilities should have a process in place to handle the suppression of airway fires, drape fires, prep solution fires and even equipment fires that can occur inside the operating room. All facilities should train and practice these techniques within their organization.

Different members of the surgical team should also know how to suppress various types of surgical fires. For example, an airway fire is almost always handled by the anesthesia provider in the room. The anesthesia provider must stop the flow of oxygen prior to extubating the patient. Failure to do so can cause the fire to burn all the way up the patient’s airway and to continue to burn inside the operating room.

Moreover, emergency procedures should clearly define surgical team members’ roles and responsibilities to identify how they will assist in evacuating the operating room should a fire occur. Proper evacuation sites should be identified and comparable to the operating room environment. For example, if a patient is taken off oxygen, suctioning or monitoring, they need an evacuation site that can accommodate oxygen, suctioning and monitoring.

Take Steps to Prevent Surgical Fires

Surgical fires are a life-changing event, not only for patients but for the staff involved. In this type of fire emergency, surgical teams are truly the first line of defense. They need to know and understand the dangers that surround them during surgery. Our experts can help you develop appropriate, hands-on training and drills to reduce the potential for loss of life and injury in a surgical fire. Learn more about Jensen Hughes fire training services.

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