How to Prevent Operating Room Fires

While the occurrence may be rare, the effects of operating room fires can be devastating.

Aimed at the estimated 50 to 100 fires that occur in operating rooms (ORs) throughout the United States each year, the American Society of Anesthesiologists has issued a Practice Advisory for the Prevention and Management of Operating Room Fires. The Practice Advisory is featured in the May issue of the journal Anesthesiology.

"Without a national reporting system for OR fires, it is hard to gauge the exact number that occur each year," said Robert A. Caplan, MD, chair of the ASA Task Force on Operating Room Fires. "The task force has developed the Practice Advisory for the Prevention and Management of Operating Room Fires to identify situations conducive to fire, prevent the occurrence of OR fires, reduce adverse outcomes associated with OR fires and identify the elements of an effective fire response."

For a fire to occur, three components or a "fire triad" must be present in the OR: an oxidizer, an ignition source and a fuel. In the fire triad, oxidizers include oxygen and nitrous oxide, ignition sources include lasers, drills and electrosurgery units, and fuels include tracheal tubes, sponges and drapes.

Key Recommendations from the Practice Advisory for the Prevention and Management of Operating Room Fires
Education
-Anesthesiologists should have fire safety education specific to OR fires and participate in OR fire drills with the entire OR team.

Preparation
-Before each surgical case, the entire OR team must determine if a case is at high risk for surgical fires.
-If a high-risk situation exists, the team must decide on a plan and roles for preventing and managing a fire.
-In every OR where a fire triad can exist, a protocol for the prevention and management of fires should be displayed.

Prevention
-Avoid using ignition sources in proximity to an oxidizer-enriched atmosphere.
-Configure surgical drapes to minimize the accumulation of oxidizers.
-Allow sufficient drying time for flammable skin prepping solutions.
-Moisten sponges and gauze when used in proximity to ignition sources.
-The anesthesiologist should collaborate with all surgical team members throughout the procedure to minimize the presence of an oxidizer-enriched atmosphere in proximity to an ignition source.
-During high risk procedures in which an ignition source is to be used in an oxidizer-enriched atmosphere, before the ignition source is activated:

• Announce the intent to use the source.
• Reduce the delivered oxygen concentration to the minimum required to avoid hypoxia.
  Stop the use of nitrous oxide.

Management
-Recognize early signs of fire.
-If fire is present, halt the procedure and initiate fire management tasks.
-For airway fires, remove tracheal tube, stop flow of all airway gases, remove all other flammable materials from airway, and pour saline into airway.
-For non-airway fires, stop the flow of all airway gases, remove burning or flammable materials and extinguish fire.
-After fire is extinguished, reestablish ventilation, assess the patient’s status and devise a plan for ongoing care.

The Practice Advisory also details recommendations for fire prevention and management in high-risk procedures, laser procedures, surgery inside the airway, for cases involving moderate or deep sedation, and surgery around the face.

"The development of this advisory was a collaborative effort that involved safety leaders in anesthesiology, nursing, surgery and equipment safety," said Caplan. "The task force was fortunate to have the insights and participation of Donna Pritchard, RN, member of AORN, David Roberson, MD, otolaryngologist at Boston Children’s Hospital and a member of the American Academy of Otolaryngology-Head and Neck Surgery, and Albert L. de Richemond, M.S., P.E., associate director of accident and forensic investigation, ECRI."

Practice advisories are systematically developed reports that are intended to assist decision-making in areas of patient care. Advisories provide a synthesis and analysis of expert opinion, clinical feasibility data, open forum commentary and consensus surveys. Advisories developed by ASA are not intended as standards, guidelines or absolute requirements. They may be adopted, modified, or rejected according to clinical needs and constraints.

For more information on the Practice Advisory for the Prevention and Management of Operating Room Fires, visit the journal Anesthesiology Web site at www.anesthesiology.org and the ASA Web site at www.asahq.org.

Source: American Society of Anesthesiologists (ASA)

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