Surgical fires don’t happen often, but when they do, the consequences can be devastating to patients and staff, resulting in serious burns, scars, disfigurement, and even death. In addition, the hospital’s equipment, facilities and reputation can be severely damaged. ECRI Institute estimates that up to 650 surgical fires occur in the U.S. every year, placing them in the Top 10 Health Technology Hazards for 2013. The most common locations for surgical fires are the patient airway (34 percent), face or head (28 percent), and elsewhere inside or on the patient (38 percent). Many Joint Commission Environment of Care (EC) standards and associated elements of performance (EPs) address fire safety:
- EC.03.01.01, EPs 1-3 call for staff and licensed independent practitioners to be familiar with their responsibilities and roles related to the environment of care. They should be able to demonstrate or describe methods for eradicating and reducing physical risks in the environment, actions to take in the event of an incident, and how to report risks.
- EC.04.01.01 requires staff and licensed independent practitioners to collect information to monitor conditions in the environment. EP 1 requires that processes be established for sustained monitoring, internal reporting, and examination of several types of conditions, including injuries to facility occupants; property damage; fire safety management problems, failures, and deficiencies; and problems, failures, and user errors related to management of medical and laboratory equipment or utility systems.
Note: Also see related requirements EC.02.03.01, EPs 9 and 10, and EC.02.03.03, EPs 1, 3, and 5, which address fire safety in general.
To reduce your hospital’s risk of surgical fires, follow these recommendations provided by the Food and Drug Administration and ECRI Institute:
- Perform a fire risk evaluation before beginning any surgical procedure.
- If using supplemental oxygen, especially for surgery in the upper chest, head, or neck area, beware of possible oxygen enrichment under the drapes near the surgical site and in the fenestration. Also, take the following precautions:
- Administer the minimum concentration of oxygen required to maintain adequate oxygen saturation for the patient.
- If high concentrations (greater than 30 percent) of supplemental oxygen are being delivered, use a laryngeal mask, endotracheal tube, or other closed oxygen delivery system.
- Do not apply drapes until all flammable preps have fully dried from the skin. Soak up any pooled or spilled agents.
- Connect all cables before activating a fiberoptic light source. Place the source in standby mode when disconnecting cables.
- Moisten sponges to make them ignition resistant during pulmonary and oropharyngeal surgery.
- Exercise caution when using alcohol-based skin preparation agents. Do not allow alcohol-based antiseptics to pool during skin preparation. Remove alcohol-soaked materials from the prep area.
- Wait for the oxygen concentration to decrease before using an ignition source, such as an electrosurgical unit (ESU) or electrocautery unit (ECU). When not in use, place the ignition source into a holster – not on the drapes or the patient.
- Foster healthy communication among surgical team members.
For further guidance, see The Joint Commission’s Sentinel Event Alert Issue 29: Preventing Surgical Fires, and ECRI Institute’s free poster, Only You Can Prevent Surgical Fires. (Contact: George Mills, email@example.com)