Safety Matters: Fire prevention in operating rooms

Operating room fires are a rare but preventable danger. In the United States each year, it is estimated that 50 to 200 fires occur in the OR.

For any fire to occur, three factors, known as a fire triad, must be present: an oxygen source, fuel source and an ignition mechanism. All three of these factors are readily available in standard operating rooms.

To be prepared in case a fire does occur, all operating room personnel receive annual training related to fires at Baptist.

“[At Baptist], a fire risk assessment is done at the beginning of each procedure,” said Martha Ullrich, system director of perioperative services. “The fire risk score is [then] announced and discussed during the time out.”

However, if a fire were to break out in the operating room, all persons in the operating room should know the location of the fire extinguishers and how to use them, said Ullrich.

Fire alarm pull stations and emergency exits are conveniently situated to facilitate orderly evacuation and extinguishing.

“Every attempt [by personnel] should be made to disrupt either the oxygen or fuel sources,” said Ullrich. “Any supplemental oxygen or nitrous oxide should be turned off [and then] ventilate the patient with room air, and use intravenous agents to maintain anesthesia.”

Nurses and doctors must also be prepared in case a fire breaks out. An acute awareness of the possibility of a fire is the best way to be prepared, said Ullrich.

However, risks to the patient should always be at the forefront of all staff’s minds when working in the operating room. Care must be taken to ensure patient safety, and it is the responsibility of the team members to control any possible hazards with all the ways a fire can start in the operating room.

To reduce the risk of fire, all surgical staff must be trained in fire prevention and extinguishing.

“All safety methods aim at keeping the fuel source, ignition mechanism and the oxygen separate,” said Ullrich. “[And at Baptist], we have put guidelines in place to keep our patients safe.”

These guidelines include:

  • Keep the electrocautery tip in the holster when it is not being used.
  • Have power going to high-intensity light sources only when they are being used. Use only appropriately protected endotracheal tubes when operating near the trachea. The most common sites of fires reported were the head, face, neck and upper chest.
  • Use air or air and oxygen mixtures in anesthetic gases.
  • Avoid tenting of surgical drapes in a fashion that allows accumulation of oxygen or other flammable gases.
  • Use water-soluble rather than oil-based substances to cover hairy parts of the body. Use fire-retardant surgical drapes.
  • Have water available on the back table and be prepared to use it in case of fire.

“Fire safety is of utmost importance and should be taken seriously by the OR team,” said Ullrich. “An effort to prevent a fire in the OR should be top priority to the staff.”