What is the requirement for determining fire extinguisher types in operating rooms?

Any examples are for illustrative purposes only.

The Joint Commission references the 2010 edition of NFPA 10 Standard for Portable Fire Extinguishers which is a mandatory reference in chapter 2 of the 2012 edition of NFPA 99, Healthcare Facilities Code. 

The organization is expected to determine and select an appropriate fire extinguisher based upon a site-specific risk assessment that would include but not limited to:

• potential fire size
• types of fuels present
• sources of ignition
• flammable skin prep products
• potential for chemical reactions with the extinguishing agent
• presence of electrical equipment

The rating of a fire extinguisher is determined by the type of fuel that is being burned.  The operating room typically has Class A fuels which would include; drapes, paper, and human tissue. Class B fuel would include flammable skin prep products. Class C fires involve energized electrical equipment. 

According to the NFPA, a water-mist or carbon dioxide extinguisher may be used in the OR. Water mist-extinguishers are rated Class 2A:C.  ECRI Institute has published information that water-mist fire extinguishers may not be appropriate in the operating room due to infection control concerns if used on a patients open surgical site cavity.  Alternatively, a close-by basin of sterile water with a sponge to quench a surgical site fire might be most appropriate.

Carbon dioxide extinguishers are rated Class B and Class C, and can also be used for Class A fires. 

Electrical fires or Class C, once the equipment is unplugged and de-energized, the fuel source is considered to be either a class A or B, allowing a carbon dioxide extinguisher to be utilized.

Additional Resources
Recommendations to Reduce Surgical Fires and Related Patient Injury: FDA Safety Communication