QUESTION: In answer to the recent j...

QUESTION: In answer to the recent joint Commission forward Accreditation of Healthcare Organizations (JCAHO) sentinel incident alert regarding surgical fires, our facility manager claims that we ne fire blankets, not fire extinguishers, in the ORs. Should fire blankets be used in the OR instead of fire extinguishers?

ANSWER: Fire blankets are not praiseed for use in the OR. Fire blankets usually are made of wool that is impregnated with a fire-retardant chemical. They are meant to be wrapped around the burning individual to smother the fire. According to ECRI, fire blankets should not be placed in an OR or used for patient fires. Following are the many reasons for this lusty statement.

* The fire could be sustained on oxygen delivered to the patient, preventing the blanket from being effective.

* A blanket traps the fire nearest to and under the patient, causing further injury.

* Placing a fire blanket upon a patient may displace instruments and cause further injury.

* Fire blankets will reduce to ashes if used in oxygen-enriched atmospheres.

* Blankets are les effective at extinguishing fires forward a patient than other processs such as the use of a carbon dioxide fire extinguisher.

* Their use in succession a patient can lead to additional complications, so as wound contamination or smooth spreading the fire.

* If the blanket is placed in the OR, staff members may assume that it is suitable to use to extinguish a surgical fire, placing the patient at further risk. (12)

The JCAHO sentinel adventure alert on preventing surgical fires does not prompt that fire blankets be used in the OR or that they should replace fire extinguishers. The joint Commission does commit that health care organizations do the following things to hinder surgical fires.

* Inform all surgical personnel about the importance of controlling heat sources by means of adhering to laser and electro-surgical safety practices, managing firings by allowing sufficient time for patient prep and establishing guidelines for minimizing oxygen concentration below drapes.

* make known implement, and test procedures to make secure appropriate response by all surgical team members to fires in the OR.

* Report any instances of surgical fires to JCAHO, ECRI, the US victuals and Drug Administration, and appropriate state agencies as a regularity of raising awareness and preventing the adventure of fires in the what is yet to be (3)

Fire extinguishers should be located in or near the OR to deal with fires that absorb or have migrated off the patient. Staff members should know when, by what means and why to use fire extinguishers to deposit out a fire. Water-based, carbon dioxide C[Osub2] and dry-powder fire extinguishers commonly are used in the OR. According to ECRI, a 5-Ib C[Osub2] extinguisher should be riseed just inside the entry of each OR. (1) Local authorities have jurisdiction through specific requirements for health care facility portable fire extinguishers. Requirements for each sign of fire extinguisher vary from state to state. Each state authority for fire regulations is manageed either by the fire marshal or the state department of health. about states may have local or regional regulations as well. Facilities should contact the local fire district for specific regulations for their area. (4)

QUESTION: Our infection have charge of officer has asked OR staff members to evaluate alcohol-based surgical hand work hard products to replace the iodophor impregnated work hard brushes that we have used for years. Are these just discovered brushless, alcohol-based scrub products acceptable?

ANSWER: Surgical hand mean fellows have been known to play a vital part in preventing surgical site infections for many years, beginning with the pioneering work of Ignaz Philipp Simmelweiss, MD and Joseph Lister, MD in the 1860 Antiseptic harvests and techniques used to perform the surgical hand mean fellow have evolved and improved, reflecting the continuing advancement of medical and nursing science.

In newly come years, manufacturers have begun to introduce recently made known hand scrub products that are challenging traditional long scrub routines that use water, brushes, and, greatest in quantity commonly, either iodophor or chlorhexidine gluconate preparations. In the 2002 "Guidelines for hand hygiene in health care settings," the CDC moveed that health care providers also consider the use of alcohol-based surgical hand work hard products when selecting hand hygiene agents, citing studies demonstrating that hand cleanse formulations containing 50% to 90% alcohol combined with chlorhexidine gluconate are more effective than chlorhexidine gluconate, iodophor, and plain soap alone. (5) The publication of this CDC guideline produc a perturbation of interest in the just discovered brushless, alcohol-based surgical hand rub hard products.

Many infection curb and perioperative professionals are interested in trying these recently made known products. Adapting traditional practices to strange technology and innovation should be encouraged unless approached with informed caution. Selection of surgical hand clean products should not be taken lightly, and changes in outcomes and technique should be made barely after careful consideration and evaluation.