Fire Preventionin the Perioperative Practice Setting

2015 AORN Fire Safety Tool Kit

Overview and Goal• Every perioperative team member should participate in

perioperative fire safety prevention strategies and be able to take action if a fire occurs.• The goal of this learning activity is to educate perioperative

team members about the recommended actions for extinguishing a fire and protecting patients and personnel.

Objectives

After completing this continuing nursing education activity, the participant will be able to:

1. Identify types of fires.

2. Discuss the steps to extinguish a fire in perioperative areas.

3. Describe how to smother a fire.

4. Identify evacuation routes.

• Fire facts• Locations• Patient injuries• Fire reports by procedure• High risk procedures• Fire safety is a team effort

Fire Facts

• Estimated frequency of OR fires

–200-240 per year in the U.S.• 44% on head, neck, or upper chest• 26% elsewhere on the patient• 21% in the airway• 8% elsewhere in the patient

Surgical Fires can occur: ANYWHERE

•Ambulatory surgery centers•Physicians’ offices•Hospitals

Patient Injuries

•Of the 200-240 OR fires per year in the U.S.–20 to 30 are serious and result in

disfiguring or disabling injuries–1 to 2 are fatal

Surgical Fires Reported by Procedure

• Cervical conization• Cesarean section• Facial surgery• Infant surgeries (eg, patent ductus arteriosus)• Oral surgery• Pneumonectomy• Tonsillectomy• Tracheotomy

High-Risk Procedures• Surgical procedures performed above the xiphoid process and

in the oropharynx carry the greatest risk – Lesion removal on the head, neck, or face– Tonsillectomy– Tracheostomy– Burr hole surgery– Removal of laryngeal papillomas

Fire Prevention is a Team Effort

• Nurses• Surgical technologists• Surgeons• Assistants• Environmental Services associates• Administration team members• Everyone else not mentioned

Types of Fires

• ON the patient

• IN the patient– Includes airway fires

• ON or IN a piece of equipment

Fighting Fires On a Patient• Announce the fire• Attempt to extinguish with water or saline• Remove burning materials from patient• Extinguish on floor• Turn off oxygen source• Obtain a fire extinguisher as last response• Save all involved materials

Fighting Fires Involving an Endotracheal Tube

• Announce the fire.

• Collaborate and assist the anesthesia professional with: – disconnecting and removing the breathing circuit– turning off the flow of oxygen – pouring saline or water into the airway – removing the endotracheal tube and any segments of the burned tube– examining the airway– re-establishing the airway

Fighting Fires On or In a Patient• Assess the surgical field for a secondary fire on the underlying

drapes or towels• Assess the patient for injury• Report injuries to the physician• Document assessment• Activate alarms if necessary• Notify appropriate chain of command

• Communicate the presence of the fire to team members• Disconnect equipment from its electrical source• Shut off electricity to the piece of equipment at the electrical

panel• Shut off gases to equipment, if applicable.• Assess the size of the fire and determine if equipment can be

removed safely or if evacuation is needed• Extinguish the fire with a fire extinguisher, if appropriate• Activate alarms if necessary• Notify the appropriate personnel

Fighting Fires On or In Equipment

How to Extinguish a Fire Using Solution

• Use a nonflammable liquid such as saline or water • Aim at the base of the fire• Remember: drapes may be impermeable

How to Smother a Fire• Hold towel between fire and patient airway• Drop the end of towel closest to the head• Drop the other end of towel over the fire• Sweep hand over towel from head toward feet• Raise the towel • Keep your body away from fire

•DO NOT PAT

•Charge nurse should notify team members when procedures are in progress•Do not start elective cases•All personnel should prepare to evacuate

How to Handle a Fire in Other Parts of the Building

Fire Blankets Not for Patient Fires!

Fire Blankets are Not Recommended!

• Fire may be sustained by O2 delivered to the patient

• Using a fire blanket – May trap fire next to or under the patient – May displace instruments

• Blanket may burn in oxygen-enriched atmospheres

NFPA Fire Classification* Class A: wood, paper, cloth, and most plastics (eg,

combustible materials)

Class B: flammable liquids or grease

Class C: energized electrical equipment

Combination: ABC, AC

* NFPA = National Fire Protection Association

Recommended Fire Extinguisher

• ECRI: Class A, B, C

• NFPA: Class A, B, C, or AC

• Check with the authority that has jurisdiction (eg, local fire marshal)

Fire Extinguisher Use “PASS”

P Pull the pin

A Aim nozzle at the base of the fire

S Squeeze the handle

S Sweep the stream over the base of the fire

Shutting Off Gases

•Find the valve location•Be familiar with valve operation•Determine when to shut off gases•Determine who can shut off gases

Sprinklers and Smoke Detectors

•Sprinkler – activated by heat– must be unobstructed

•Smoke detector– sounds alarm

Evacuation Types and Areas

•Who determines when to evacuate•Lateral, horizontal, or vertical evacuation•Fire doors•Smoke compartments•Evacuation floor plan maps

Evacuation Steps: Use “RACE”

R Rescue

A Alarm

C Confine

E Evacuate

SummaryIn order to extinguish a fire you must

1. Know methods to extinguish a fire

2. Know how use an extinguisher

3. Know how to evacuate

References

Guideline for a safe environment of care, part 1. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2015:239-263.

ECRI Institute. New clinical guide to surgical fire prevention. Patients can catch fire—here’s how to keep them safer. Health Devices. 2009;38(10):314-332.

Clarke JR, Bruley ME. Surgical fires: trends associated with prevention efforts. Pennsylvania Patient Safety Advisory. 2012;9(2):130-135.

Centers for Medicare & Medicaid Services. State Operations Manual. Appendix A—Survey Protocol, Regulations and Interpretive Guidelines for Hospitals. http://cms.gov/manuals/Downloads/som107ap_a_hospitals.pdf. Accessed January 28, 2015.

National Fire Protection Association Technical Committee on Portable Fire Extinguishers. NFPA 10: Standard for Portable Fire Extinguishers. Quincy, MA: National Fire Protection Association; 2010.

The End