Perioperative

Safety PlanBy: Jennifer Deering, SCSU Capstone Student

Overview

To educate perioperative personnel on the history and

risks of surgical fires and essential fire safety practices

for the perioperative environment.

Fire safety & History

• Perioperative fire safety is very important and can be

prevented. The Emergency Care Research Institute (ECRI)

has a mission to “Research the best approaches for safety,

quality, and cost-effectiveness in healthcare, ultimately

enabling your organization to improve patient care.”

• According to ECRI, surgical fires are rare: They occur in only

an extremely small percentage of the approximately 65

million surgical cases each year. As of 2012, it is estimated

that approximately 240 fires occur nationally each year,

making the frequency of their occurrence comparable to that

of other surgical mishaps such as; wrong-site surgery or

retained instruments.

ECRI.org

The Fire Triangle

A central concept of fire prevention is the fire triangle. It is

based on the fact that in order for a fire to start, it requires

oxygen, heat and fuel.

-Oxygen is an oxidizing source

-Heat is an ignition source

-Fuel is any material that has

the ability to catch fire

Fire Triangle Sources• Oxidation Sources include:

o Oxygen

o Nitrous oxide

• Ignition Sources include:

o Elecrocautery devices

o Active electrosurgical electrodes and lasers

o Fiber-optic light cords and flexible endoscopes

o Defibrillators

o Cutting devices, heated probes and anything that creates heat

• Fuel Sources include:

o Flammable prep agents, sponges, drapes, tape, bandages, dressings

o Towels, aerosols, plastics, hair

o Petroleum and oil-based lubricants or ointments

o Methane gas from the gastrointestinal tract and alcohol vapors

o Wax and collodion (Mixture of pyroxylin, ether and alcohol)

http://www.youtube.com/watch?v=14H5Q3qGyVo

APSF.org Fire Safety Video

December 2010

Statistics“Electrocautery was the ignition source in 90% of fire claims.

Most (85%) electrocautery fires occurred during head, neck, or

upper chest procedures. Oxygen served as the oxidizer in 95%

of electrocautery-induced OR fires. Most electrocautery-

induced fires occurred during monitored anesthesia care. In

contrast, alcohol-containing prep solutions were present in only

15% of OR fires during monitored anesthesia care.”

“In conclusion, electrocautery-induced fires during monitored

anesthesia care were the most common cause of OR fires

claims. Recognition of the fire triad (oxidizer, fuel, and ignition

source), particularly the critical role of supplemental oxygen by

an open delivery system during use of the electrocautery, is

crucial to prevent OR fires. Continuing education and

communication among OR personnel along with fire prevention

protocols in high-fire-risk procedures may reduce the

occurrence of OR fires.”Mehta, S., Bhananker, S., Posner, K., & Domino, K. (2013). Operating room fires: A closed claims analysis.

Anesthesiology, 118(5), 1133-1139. doi:10.1097/ALN.0b013e31828afa7b

Perioperative Fire Extinguishers on A Level

Total Fire Extinguishers: 43

Surgery Area: 30

Perioperative Care: 13

Fire Risk Assessment Tool

Every patient will be assessed preoperatively using the Fire Risk Assessment Tool.

1. One point will be assigned for each of the four risk factors:

• Is an alcohol based prep agent or other volatile chemical being used preop?

• Procedure site above or below xyphoid.

• Open oxygen source: face, mask, or nasal cannula.

• Ignition source in use – cautery, laser, or fiber optic light source,

defibrillator, drill/saw/burr, and lithotripsy.

-Circulating RN will announce the Fire Risk Score in Timeout before procedure starts

-Score 1-2 Low Risk

-Score 3-4 High Risk

2. Fire risk score of 1-2 will implement recommended precautions:

a. Allow prep to dry at least 3 minutes before draping

b. Do not allow pooling of any prep solution (including under the patient)

c. Use standard drapes

d. Utilize cautery pencil holster

e. Utilize laser standby mode

f. Turn off fiber optic heat source when not in use

g. Remember, low scores can convert to high scores.

3. Fire risk score of >3 is a high risk. Implement the low risk precautions

plus:

a. Titrate deliverable Oxygen to 30% or below

b. Utilize appropriate draping techniques to minimize oxygen concentration

(tenting, draping, etc.).

c. Use minimal cautery settings

d. Moisten all sponges

e. Have a dedicated sterile basin and syringe of saline available for fire

suppression only.

f. Have a syringe of sterile saline available to anesthesia for procedures in the

oral cavity.

Document staff involved during the timeout and verify the time

Once accepted, the Timeout section will look like this:

Types of fires

In non-OR fires, the RACE acronym is a reminder for practitioners

to rescue, alarm, confine, and extinguish fires. However, in OR fires

this sequence may not be appropriate depending on the type of fire.

OR fires may be subdivided into:

(1)Fires occurring on the patient

(2)Fires occurring in the patient

(3) Fires occurring in the OR environment

**Each member of the team has a specific role set forth by the SCH

Policy

Hart, S., Yajnik, A., Ashford, J., Springer, R., & Harvey, S. (2011, November 18). Abstract. Retrieved October 11,

2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096161/

Roles of the staff according to SCH Policy

The Surgeon should:

1) Remove any burning material from the patient or sterile field, and extinguish it

on the floor.

2) Control bleeding and prepare the patient for evacuation if necessary.

3) Conclude the procedure as soon as possible.

4) Place sterile towels or covers over the surgical site.

5) If the patient is not in immediate danger, help move the patient if necessary.

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

The Anesthesia care provider should:

1) Shut off the flow of oxygen/nitrous oxide to the patient or field and maintain breathing for

the patient with a valve mask respirator (ambu bag).

2) Collaborate with the Charge RN/Circulating RN on the need to turn off the medical gas

shutoff valves.

3) Disconnect all electrically powered equipment on the anesthesia machine.

4) Disconnect any leads, lines, or other equipment that may be anchoring the patient to the area.

5) Maintain the patient’s anesthetic state and collect the necessary medications to continue

anesthesia during transport.

6) Place additional IV fluids on the bed for transport with the patient, if time permits.

7) For cardiac procedures with the heart/lung bypass machine in use, raise the OR table to the

highest level and place heart/lung machine under the foot of the bed prior to

immediate evacuation from room.

Roles of the staff according to SCH Policy

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

The scrub person should:

1) Remove any burning material from the patient or sterile field, and

extinguish it on the floor.

2) Assist with the conclusion of the procedure if possible.

3) Obtain sterile towels or covers for the surgical site and instruments.

4) Gather a minimal number of instruments onto a tray or basin and

place them with the patient for transport.

5) Assist with patient transfer while on the OR table for transport out of

the OR.

Roles of the staff according to SCH Policy

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

The Circulating RN should:

1) Ensure patient’s safety by remaining with and comforting the patient.

2) Activate the fire alarm system and to alert all necessary personnel.

3) Notify the Charge RN who will page overhead to alert any available personnel

able to provide assistance

4) Determine the number of responders needed and delegate duties, releasing staff

as needed.

5) Extinguish small fires not on the sterile field or douse them with liquid if

appropriate. Every operating room is equipped with a Carbon Dioxide

fire extinguisher.

6) Assist with the removal of any burning material from the patient or sterile field,

and extinguish it on the floor.

7) Prevent the fire from spreading to shoes or surgical clothing by not stepping on

it.

Roles of the staff according to SCH Policy

Continued on next page

8) Provide the scrub person and anesthesia care provider with the needed

supplies.

9) Collaborate with the anesthesia care provider on the need to turn off the

medical gas shutoff valves.

10) Carefully unplug all equipment if the fire is electrical.

11) Be aware of the safest route for escape.

12) Obtain a transport stretcher if necessary.

13) Remove IV solutions from poles and place them with the patient for

transporting out of the OR.

14) Help the anesthesia care provider, perfusion, and cell saver personnel, as

applicable. Disconnect any leads, lines, or other equipment that

may be needed for transporting the patient

15) Do not delay in leaving the OR suite.

The Circulating RN Role Continued

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

The Charge RN:

1) Collaborates with affected OR staff and notifies Security personnel as necessary.

2) Document the time the fire started.

3) Set up a communication point and identify a person to staff it

4) Determine the state of ongoing surgery/procedures in each area.

5) Consult with the anesthesia care provider in charge on how to handle each patient.

6) Assign personnel to assist where needed.

7) Ask visitors to leave if necessary.

8) Evacuate patients who may need to be moved immediately.

Roles of the staff according to SCH Policy

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

Ancillary/Assisting personnel:

1) Help clear corridors for evacuation

2) Secure equipment for transporting the patient as directed by the Circulating RN.

3) Help prepare a safe area to transfer patients as necessary.

4) Follow instructions for evacuating the patient as necessary.

5) Assist where directed.

-After evacuation of the room, the last person to leave should close the doors and

place a wet towel at the base.

-After the fire is extinguished, everything must be left in place to allow the safety

officer and the Fire Department to conduct a thorough investigation of the cause of

the fire.

Roles of the staff according to SCH Policy

SCH FIRE SAFETY PLAN – PERIOPERATIVE CARE

**Every team member plays a important role in the

Perioperative Fire Safety.

**Speak Up if any precaution is missed or

overlooked.

**Ensure you are doing your part to prevent

perioperative fires.

REMEMBER:

Test your knowledge

What three components make up the Fire Triangle?

Oxygen, Heat and Fuel

Test your knowledge

Where do most On Patient fires occur?

Above the xyphoid

Test your knowledge

If you have questions regarding what your role

is during a fire emergency, where do you find

that information?

Under Policies and Procedures in CentraNet

Policy called:

FIRE SAFETY PLAN – PERIOPERATIVE CARE

QUESTIONS??

Surgical fire prevention. ECRI Institute.

https://www.ecri.org/Products/Pages/Surgical_Fires.aspx?sub¼ Customized%20Services.

References

Mehta, S., Bhananker, S., Posner, K., & Domino, K. (2013). Operating room fires: A closed

claims analysis. Anesthesiology, 118(5), 1133-1139. doi:10.1097/ALN.0b013e31828afa7b

Hart, S., Yajnik, A., Ashford, J., Springer, R., & Harvey, S. (2011, November 18).

Abstract. Retrieved October 11, 2014, from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096161/

Saint Cloud Hospital Policy: Fire Safety Plan – Perioperative Care

APSF.org Fire Safety Video