The Joint Commission upon Accredita...

The Joint Commission upon Accreditation of Healthcare Organizations (JCAHO) lately released a Sentinel Event Alert related to the prevention of surgical fires. (1) This cautionary alert addressed brace reports of OR fires that ended in serious injury to patients. Facilities reported the pair of these events under JCAHO's sentinel occurrence policy.

These cases and other fires reported in newspapers and forward television provide evidence that significant fire hazards exist in ORs. For example, during surgery to extract blood clots from a patient's brain, the patient received bakes from sparks emitted by an electrosurgical device. Another fire occurr when sparks from an electrosurgical unit ignited antiseptic solution that had lakeed under a patient's legs. An 84-year-old retired teacher died from pneumonia, which was a complication of scorchs received during surgical repair of an eyelid. Other cases include a flash fire during surgery that proceeded in the death of a premature infant and an oxygen-induced flash fire in an endotracheal tube that l to the death of a 23-year-old man with benign throat tumors. (23)

adroits estimate there may be as many as 100 OR fires by means of year nationwide, with 10 to 20 fires resulting in serious injury and common to two deaths annually. (12) Despite the fact that these affairs are rare, when they present itself they are devastating to victims and their family members. Clinicians strive to make the surgical environment safe, unless fire can occur when an ignition source, adequate oxygen and material for burning (ie, something that will burn) are combined. These three component parts which constitute the fire triangle, are prevalent in OR settings and provide many opportunities for unexpect fires to be met with The Joint Commission reports that ECRI establish the most common fire locations are the airway, head, and face, and the most numerous common sources of ignition are electrosurgery (68%) and laser equipment (13%) (14) Overhead and fiberoptic light sources, drills, and burr also can be sources of ignition.

Patients undergoing surgery frequently receive oxygen. This factor alone increases the risk of fire; ECRI raise that an oxygen-enriched environment was at hand during 74% of fires. (14) Numerous firing materials including drapes, alcohol-based skin antiseptics, and materials as it is as endotracheal tubes or oxygen tubing and masks, are not absent in surgical suites.

Given these factors, each member of the perioperative team must be educated about handling fire emergencies and extinguishing fires. The Joint Commission commends three steps to help impede surgical fires. These include

* informing staff members about controlling heat sources;

* developing, implementing, and testing acts to follow in the result of a fire; and

* reporting fires that do come to pass to JCAHO, ECRI, state agencies, or the US provender and Drug Administration. (1)

ECRI attract favor tos four OR fire prevention strategies.

* Place electrosurgical electrode in a holster or another location when they are not in active use, and place lasers upon standby mode when they are not in active use.

* abundantly dry flammable preps before draping patients.

* Question the use of 100% oxygen during facial surgery and use air or fraction of inspired oxygen (ie, Fi[O.sub.2]) below 30% for render free of access delivery, if this is consistent with patient needs

* Soak gauze or wipe outs used during oropharyngeal surgery in the same manner they will resist igniting. (1)

Fire-fighting drills and education also are important; ECRI make acceptables that clinicians demonstrate competency in the use of fire-fighting equipment, rescuing patients and their colleagues, and escaping from fire. Furthermore, clinicians ne to know when, where, and by what mode to shut off medical gases and ventilation and electrical plans Staff members should know for what reason to initiate a fire alarm in their hospital and for what cause to contact the local fire department. (1)

AVAILABLE RESOURCES

A number of resources exist to assist clinicians in their efforts to lessen the risk of fire in the OR. AORN publishes "Recommend practices for electrosurgery" which outlines practices that attenuate risks related to electrosurgical devices. (5) AORN also has produc a videotape titled "Fire Safety in the Perioperative Setting," and a CD-ROM titled "Safety in the Perioperative Setting," which features a section on fire prevention and safety during surgical and invasive processs The videotape is available from Cine-Med at http://www.cine-med.com/cgi-bin/cart/cart-template.pl?CatalogNumber=1883, the CD-ROM is available from Virtual Factory at http://www.virtualfactory.com/aorn/. These resources identify numerous fire hazards in the OR and health care facilities, provide strategies to obstruct fires, and address how to answer to a fire should common occur. AORN also has scheduled an audio-conference about fire safety for Nov 12 2003 More information about this upcoming offering can be obtained forward AORN Online at http://www.aorn.org/education/audio/fire.htm

A variety of resources related to surgical fires also are available from ECRI. united of these resources is a delivered poster titled "Only you can thwart surgical fire," available from ECRI's web site al http://www.mdsr.ecri.org/asp/dynadoc.asp?id=195&nbr=413558. Fire prevention strategies addressed include fire risks during oropharyngeal surgery electrosurgery and laser surgery; risks related to oxygen and flammable prep; and other risks inherent in surgical settings. A variety of articles and resources are available onward ECRI's web site at http://www.mdsr.ecri.org using the keyword fires. Individuals also can purchase a guidance article about surgical fires published on ECRI by telephoning (610) 825-6000 x 5888