Q. To which setting and services does this goal apply?
A. The risk of surgical fires may be present whenever and wherever surgery or other invasive procedures are performed, whether in a hospital operating room, a physician's office, an outpatient clinic, or an ambulatory surgery setting including endoscopy centers, interventional and diagnostic radiology centers, and any setting where the elements of surgical fires are present. While this goal is only applicable to the Ambulatory and Office-Based Surgery Accreditation Programs for scoring purposes, we still encourage hospitals to implement the recommendations that were published in Sentinel Event Alert #29 (2003) and reflected in the requirements for this goal.
Common elements of surgical fires
Q. What are the most common elements of surgical fires?
A. The three basic elements of surgical fires constitute the traditional fire triangle. In the surgical/procedure setting, these elements may be present in the following forms:
- Ignition sources include electrosurgical equipment, surgical lasers, electrocautery equipment, fiberoptic light sources, and defibrillators.
- Oxidizers include oxygen-enriched atmospheres, nitrous oxide, medical air, and ambient air.
- Fuels include common OR material such as mattresses, sheets, gowns, towels, drapes, dressings, and sponges. Other fuels include volatile organic chemicals, body hair, intestinal gases, tracheal tubes, and body tissue.
Alcohol-based skin preps
Q. Does this mean we can’t use alcohol-based skin preps?
A. Alcohol-based skin preps can be used during all procedures, including those with cautery or electrosurgery, as long as strict safety precautions are followed to prevent surgical fires. The National Fire Protection Association (NFPA), mandates that staff follow procedures to prevent surgical fires, including the following strategies:
- Ensure that any alcohol-based solution used in the operating room is clearly labeled as highly imflammable and included clear instructions for its use.
- Avoid runoff and pooling of alcohol-based skin preparations by using the least amount necessary, avoiding the use of spong applicators, and allowing the solution to dry completely before draping.
- Empower the operating room staff to call a “time out” before starting surgery to ensure the following: alcohol-based solutions do not soak into the hair or linens, sterile towels used to absorb drips and runs during application are removed prior to draping the patient, and solution-soaked materials are removed from the operating room before draping or using electrosurgery or electrocautery units or lasers.
- Use electrosurgical instruments on the lowest possible setting to minimize the risks of sparking and excessive temperatures.
- Place electrosurgical instruments in their holders when not in use.
- Avoid placing surgical drapes over nasal cannula.
Organizations can also find helpful recommendations for preventing surgical fires at the ECRI Institute website.