Operating room (OR) safety is a paramount concern for healthcare professionals, and one of the most important aspects of OR safety is fire prevention and management. Unfortunately, many facilities overlook fire safety due to misconceptions about the frequency and preventability of OR fires. While OR fires that necessitate pulling the alarms are rare, any amount of flame can have devastating consequences when they occur.1 It is crucial for healthcare professionals to prioritize fire prevention and be aware of the risks associated with OR fires. Continuous training and coordination among various hospital departments can help minimize the possibility and mitigate the effects of a fire.
In this blog, we explore the components of an OR fire, the importance of proactive fire prevention, and how to manage a fire if such a situation occurs.
Understanding Operating Room Fires
A fire requires three components: an oxidizer, an ignition source, and fuel. These components form the fire triangle. The key to fire prevention lies in mitigating the risks associated with these elements to prevent combustion.
Oxidizer: Oxygen and nitrous oxide are common oxidizers found in the operating room. Both of these gases can significantly enhance the rate of combustion and lower the ignition temperature of fuels, increasing the likelihood of a fire.
Ignition Source: Surgeons are usually responsible for the ignition source in the operating room. Common sources include electrocautery devices, fiber-optic lighting, and lasers used during airway surgeries.
Fuel: The circulating nurse often manages the fuel source in an operating room. Examples of common fuel sources include alcohol-based skin preparations, drapes, and gauze. With alcohol-based skin preparations a preferred disinfection method, OR personnel must apply these solutions correctly.
What to Do When a Fire Breaks Out?
The instant the early signs of a fire are detected, OR teams must halt procedures and initiate fire management tasks. In airway fires, the team should:
- Remove the tracheal tube
- Stop the flow of all airway gases
- Remove flammable materials from the airway
- Pour saline into the airway
For non-airway fires, the team must:
- Stop the flow of all airway gases
- Remove burning or flammable materials from the patient
- Extinguish the fire
Once the fire is extinguished, the team should reestablish ventilation, assess the patient’s status, and devise a plan for ongoing care.
Mastering OR Fire Safety
The three key aspects of OR fire safety are effective communication, drills and preparation, and carefully planned risk mitigation and prevention strategies. With a complete understanding and implementation of these principles, you can create a safer operating room environment and better protect both patients and staff from fires.
Communication is crucial when a fire breaks out in the OR. Circulators should clearly announce the fire and coordinate with other team members. The entire team, including surgeons, nurses, techs, and anesthesia staff, should work together to control gases, extinguish the fire, and maintain patient care. In case of evacuation, communicate the fire exit direction and evacuation route, remembering to close doors to contain the fire.
Fire Drills and Preparation
It is essential to have fire drills in place for OR teams to practice and develop muscle memory and ensure everyone acts accordingly. Organize a mock fire drill, allocating an hour of in-service time for the event. Divide surgical teams into individual suites, with safety team members and OR leadership facilitating the action. Provide facilitators with identical worksheets listing code red scenarios to ensure standardized testing conditions. After the drill, have OR teams complete anonymous surveys for non-punitive feedback to measure education progress and identify improvement areas.
Mitigating Risk and Preventing Fires
The American Society of Anesthesiologists (ASA) recommends the following measures to prevent and manage OR fires:2
- Anesthesiologists should obtain fire safety education specific to OR fires and participate in fire drills with the entire OR team.
- Before each surgical case, the team should assess fire risk and establish a plan for preventing and managing a fire.
- Display the protocol for preventing and managing fires in every OR where a fire triad can exist.
- Upgrade your safety measures with adequate fire prevention (including GloShield!), containment, and suppression systems.
Raise Your Standard of OR Fire Prevention
Fire safety in the operating room is critical to overall patient care. Healthcare professionals must prioritize proactive fire prevention, understand the components of OR fires, and be prepared to manage them when they occur. By incorporating the concepts here into your OR, along with ongoing fire safety training and innovative preventive solutions like GloShield, you can reduce the risk of OR fires and protect patients and staff. Contact us to talk with an expert and request complimentary samples of GloShield.
- Hart, S. R., Yajnik, A., Ashford, J., Springer, R., & Harvey, S. (2011). Operating Room Fire Safety. Ochsner Journal, 11(1), 37-42. PMCID: PMC3096161. PMID: 21603334. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096161/#:~:text=At%20the%20first%20sign%20of,100%25%20oxygen%20for%20the%20patient
- Apfelbaum, J. L., Caplan, R. A., Barker, S. J., Connis, R. T., Cowles, C., Ehrenwerth, J., Nickinovich, D. G., Pritchard, D., & American Society of Anesthesiologists Task Force on Operating Room Fires. (2013). Practice Advisory for the Prevention and Management of Operating Room Fires: An Updated Report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology, 118(2), 271-290. https://doi.org/10.1097/ALN.0b013e31827773d2