Fire in the OR—Prevention and preparedness

AORN Journal,  July, 2004  by Liane Salmon

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The article "Fire in the OR--Prevention and preparedness," is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is July 31, 2007.

Complete the examination answer sheet and learner evaluation found on pages 59-60 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journol/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on fires in the OR, nurses will be able to

1. identify elements of the fire triad that are available in ORs,

2. discuss staff member responsibilities when using the RACE acronym,

3. describe the steps that one facility followed to plan a fire drill, and

4. explain how evaluation forms can be used to improve staff member performance during a fire drill.

Approximately 100 fires occur in ORs across the United States every year. (1) Patients are severely injured or die in approximately 20 of these fires. (1,2) Fires in the OR can be devastating to patients, surgical team members, facilities, and communities, and every OR, no matter what the size or setting, contains the ingredients necessary to start a fire.

Education is the key to fire prevention and preparedness. (3) All staff members need to be educated regarding

* causes of OR fires,

* strategies to reduce the possibility of a fire, and

* what to do if a fire occurs.

FIRE PREVENTION

Fires start in the OR because the elements of the fire triad are allowed to converge. The fire triad is a triangle on which each point represents a factor that must be present for a fire to begin. (4) The three factors are fuel, oxygen, and heat (Figure 1). Many examples of these components are available in the OR, and all members of the surgical team, including OR staff members, anesthesia care providers, and surgeons, must work together to prevent the elements of the fire triad from converging to start a fire. (5,6) Caregivers can prevent fires in the OR by minimizing just one component of the triad. For example, providers can minimize fuel sources by

* allowing skin prep solutions to dry before draping the patient,

* coating facial hair with a water-soluble lubricant,

* prohibiting large volumes of 10% buffered formalin in the OR because it is explosive, and

* using special laser endotracheal tubes for oral laser surgery. (7,8)

[FIGURE 1 OMITTED]

In addition, the OR can be an oxygen-rich environment. Caregivers should work cooperatively to reduce the amount of oxygen in the OR by

* placing drapes in a way that allows trapped gases to escape;

* turning off oxygen during defibrillation or cardioversion;

* using no more oxygen than is necessary to maintain adequate oxygen levels; and

* questioning the need for 100% oxygen, especially during head and neck procedures.

Heat also is prevalent in the OR. Caregivers can reduce the heat component by

* activating the electrosurgical unit (ESU) hand piece only when the tip is visible and touching the tissue to prevent arching;

* allowing only one foot pedal (eg, ESU, laser, microscope) for the surgeon at a time;

* inspecting all electrical cords for fraying before plugging them into an outlet;

* keeping the tip of the hand piece clear of eschar to prevent heat build up;

* maintaining equipment so it is in good working order;

* not allowing an activated fiberoptic cable to test on a drape;

* placing lasers on standby when they are not in use;

* using flat-finished instruments to prevent reflection of a carbon dioxide laser beam to an unprotected area; and

* using an ESU pencil holster to prevent accidental activation when the hand piece is lying on the drape.

FIRE PREPAREDNESS

One component of fire safety is educating staff members on what to do if a tire does occur. Perioperative managers and educators must review fire safety procedures with staff members when they are hired and on an annual basis. It is not enough to discuss fire safety theoretically; a facility's specific fire plan must be discussed, understood, and demonstrated by all perioperative staff members. Many health care facilities use the acronym RACE as a foundation for the preparedness portion of their fire safety plan.

* R--rescue those in danger, including patients, visitors, and staff members.

* A--alert others to the fire using pre-determined methods.

* C--contain the fire by closing windows and doors to minimize the spread of fire and smoke.