3 Risks for Fire in the OR & the Interventions You Need to Protect Patients

Your Practice: Fire Safety Week

During the week of Oct. 9, AORN reminds the periop community that there are significant risks for fire to erupt in the OR setting. Every member of the team plays a role in preventing surgical fire.

Oxygen, ignition, fuel … when these fire risks are in play, surgical patients are in danger. You can prevent surgical fires by knowing the risks AND being prepared to intervene as a team. Here’s a streamlined refresher on the actions you can take to prevent fire in your OR.

Is my patient at risk for surgical fire?

This is a question teams should be asking before every case because the right combination of oxidizer (oxygen or nitrous oxide), ignition source (such as electrocautery), and fuel (such as alcohol-based skin prep solution) can ignite a fire.

Surgical fires happen more frequently than you’d think. Around 50–100 surgical fires are reported annually.

This number is likely higher when you consider the number of surgical fires that are caught before a patient is harmed and aren’t reported, according to Renae Wright, DNP, RN, CNOR, perioperative practice specialist and author of fire safety practice recommendations in the Environment of Care guideline.

“When a surgical fire does erupt, the effects can be devastating, risking permanent disfiguration and death.”

A New Tool to Assess Fire Risk

Fire risk assessment is part of the pre-procedure timeout, but a word of caution. “Best practices to support this work have been misguiding,” Wright says. For example, she describes a common process for fire risk assessment based on a score of low, medium, or high risk, but stresses that a score doesn’t protect a patient.

“Just grading the level of risk doesn't help teams intervene in a way that addresses the specific fire risks that may be present."

That’s why she created AORN’s new Fire Risk Assessment and Prevention Algorithm. It's a one-page tool teams can hold and display in their ORs. The tool will be released in December with updated fire safety practices in the revised Environment of Care guideline.

Don’t worry, no need to wait.

Turning the Focus on Fire Prevention Action

With Fire Safety Awareness month happening now, Periop Today got an early look at the Algorithm. It simplifies fire risk assessment down to these 3 quick questions teams can ask when they run their surgical safety checklist:

1. Is an alcohol-based skin antiseptic or other flammable solution being used preoperatively?
2. Is open oxygen or nitrous oxide being administered and/or is the operative site above the head, neck, chest, or in the oropharynx?
3. Is an electrosurgical unit, laser, fiberoptic light or other ignition sources like defibrillators, drills, saws, or burrs being used?

Depending on the answer, teams then have a list of actions in front of them they can consider to protect the patient from fire.

While fire risk assessment and prevention must be planned and implemented by individual teams, Wright shared a few of the interventions from the more comprehensive interventions listed in the Algorithm to help teams turn fire risk knowledge into action today:

Fire Risk: An alcohol-based skin prep is being used.

Possible Safety Interventions:

• Allow skin antiseptic agents to dry completely.
• Avoid pooling by absorbing excess solution.
• Remove saturated materials from the patient care vicinity

Fire Risk: Open oxygen or nitrous oxide is being administered.

Possible Safety Interventions:

• Cover hair near the surgical site with water-soluble gel and use water-based ophthalmic lubricant in the eyes.
• Configure drapes to allow oxygen to flow freely and not accumulate under the drapes.
• Use moistened radiopaque sponges near oxidizers and ignition sources.
• Notifying the anesthesia professional before using an ignition source.

Fire Risk: An electrosurgical unit, laser, or fiberoptic light being used.

Possible Safety Interventions:

• Use non-conductive safety holsters or a protective cap as intended.
• Use the lowest possible power settings.
• Moisten radiopaque sponges and towels used near ignition sources.
• Place laser or light source in standby mode when not in active use.
• Don’t activate ignition sources in the presence of flammable agents until the agents are dry, and vapors have dissipated.
• Connect all cords and cables before activating devices and keep working ends away from potential fuel sources.
• Verify that water or saline, and a fire extinguisher are available.

Fire Safety Resources for the OR

Stay tuned for publication of the new Fire Risk Assessment and Prevention Algorithm and other guideline implementation tools that will release in December on eGuideliines+ with the updated Environment of Care guideline.

Review other Fire Safety Resources currently available in the Fire Safety Took Kit (open access) to reinforce surgical fire prevention today.

(Every October during the week of Oct. 9, the US and Canada recognize fire prevention to commemorate the Great Chicago Fire of 1871.)

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