Fighting fire with fire safety

AORN Journal, Oct, 2006 by Paula R. Graling

The Great Chicago Fire was one of the largest disasters to occur in the United States during the nineteenth century. The conflagration burned for three days, from Oct 8 to 10, 1871, killing hundreds of people and destroying most of downtown Chicago. According to historic reports, the fire cleared a path of destruction about four miles long, averaging three-quarters of a mile wide and encompassing more than 2,000 acres. This area included approximately $222 million in property--a third of the city's valuation. The then-new Chicago water tower survived the fire and remains today as an unofficial memorial to the fire's destructive power, since it was one of only five public buildings spared by the flames. (1)

Many stories have been told about how the fire may have been started. Some claim that boys were smoking in the haystacks, another report blames a craps game, others report a meteor shower in the area, and the most publicized story involved a cow kicking over a lantern in the O'Leary barn? In commemoration of the Great Chicago Fire, October is designated National Fire Safety Month.

Or Fries

Operating room fires occur about 100 times per year, and about 20% of those fires cause harm. (2) (p251) The basic elements that can cause a fire are always present in the OR, and fire safety can be as easy as communicating about efforts to minimize all aspects of the fire triangle (ie, ignition source, fuel source, and oxidizer). This seems like common sense, but surgical fires still occur.

In a recent report published in The Washington Post, a woman discussed the severe burns sustained by her 73-year old mother when a fire occurred during surgery to insert a breathing tube into her mother's trachea. (3) Reactive chemicals exposed to oxygen were deemed to be the cause of the incident. The daughter has become the spokesperson for a group called SurgicalFire.org (4) to educate others about the risk of surgical fires. (3)

The article also mentions several other surgical fires, including one that caused the death of a woman who was undergoing minor eyelid surgery, the case of a newborn who suffered second- and third-degree burns during a procedure, and the very recent case of a man whose beard caught fire from the alcohol-based skin prep solution that was used to prep him for throat surgery. The article calls attention to the continuing need to educate perioperative personnel about fire risks and the need for mandatory reporting of fires because currently no uniform reporting system exists. (3)

AORN Efforts

AORN is addressing fire safety in many ways. The "AORN guidance statement: Fire prevention in the operating room," (2) originally published in May 2005, provides a written resource for clinicians and others to readily access information. In July 2006, AORN and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) held a joint webinar to expand knowledge of National Patient Safety Goal (NPSG) 11 (ie, reduce surgical fires) (5) and to provide implementation strategies to meet JCAHO survey criteria. This webinar was a cooperative effort between a safety manager, Jen Carlson, BS, from Advocate Christ Medical Center and Hope Children's Hospital, Oak Lawn, Ill, and me, a perioperative clinical nurse specialist. During the webinar, we discussed the NPSG, root causes of OR fires, successful risk-reduction strategies, recommendations provided by Sentinel Event Alert 29, (6) and best practices for supporting ongoing safety initiatives.

Despite these successful ventures, AORN still believes that tools are needed to

* meet everyday practice needs,

* help with the annual competency work for evacuation planning and fire drills,

* raise awareness of the need for increased communication and collaborative planning in the era of OR efficiency and cost reduction,

* make fire safety measures a natural progression of work and not an added burden to the already filled agenda of the perioperative team, and

* help the perioperative team plan care for their patients and themselves. Thus, the Perioperative Fire Safety Tool Kit was conceived.

The Tool Kit

The Perioperative Fire Safety Tool Kit has been the work of a multidisciplinary Headquarters team. When I asked each of them to tell me what they thought was the best way to describe the tool kit, several themes emerged: unique, collaborative, emotional, and community-minded. The cooperation we have had from our partners outside of AORN has been tremendous.

These partners include experts from ECRI, the American Society for Healthcare Risk Management, the American Society for Healthcare Engineering, and Phillips and Associates, as well as the Hartford, Conn, deputy chief fire officer and family members of patients who have experienced a fire in the perioperative area. We could not have created this resource without their willingness to put together such a quality product for improving safety. The Perioperative Fire Safety Tool Kit includes the following components to help organizations develop a proactive fire safety plan: