The Importance of the Fire Risk Assessment

ORs are environments ripe for fires. The three components of fire (ie, an oxidizer, an ignition source, fuel) are present in the OR during almost every procedure. Oxygen and the anesthesia gases are very flammable, and one is used at some point in just about every procedure. There are many different ignition sources; some seem very noticeable and some not. For instance, everyone’s first thought is the electrosurgical unit for an ignition source. That usually is the most common, but many don’t think of light cords or power equipment, which also can start fires in the OR. Fuel is everywhere for OR fires. Drapes, sponges, hair, and prep solution are just a few examples.¹ Fires in the OR are very preventable, however, if staff members follow proper guidelines.

Fire Risk Assessment and Education

A fire risk assessment should be done prior to the start of every case, and the fire risk should be discussed with the entire surgical team during the time out. This will keep everyone aware of how elevated the risk for a fire is during each procedure and what aspects of the procedure the risks are coming from, both of which can help prevent a fire from happening. Staff should also have, at a minimum, yearly fire safety education. This will give staff direction as to what to do should a fire start. A properly trained, quick-thinking surgical team can make all the difference in the event of an OR fire.

My Fire Story

In 2017, we had a fire in my OR—on a patient! The woman was newly diagnosed with breast cancer and was getting her port placed for chemotherapy. As if this woman did not have enough stress going on in life already, she left our OR intubated and with burns to her face and neck and was flown to a burn center; all when she was just coming in for a routine port placement.

Lessons Learned

There were multiple things that we missed that could have prevented this fire from happening. This procedure had three risk factors for a fire: the patient was having surgery above the xiphoid and was receiving sedation with oxygen via face mask and the surgeon was using an alcohol-based prep solution. There also was no isolation drape in place, since this was not our practice at the time; evidence-based research has since shown that these drapes work to prevent surgical fires above the xiphoid.  

Our biggest miss was that we did not do a proper fire risk assessment and communicate it among the team members. Everyone was in a hurry. Radiology was delayed and the surgeon was behind, which created a perfect storm in which we were able to miss such an important step. We also did not wait 3 minutes for the alcohol-based prep solution to dry; instead, the surgeon prepped and then immediately draped the patient. The patient was having difficulty maintaining her saturation, so the anesthesia provider had the oxygen at almost 100%.

All these factors should have been communicated in the fire risk assessment. If they had been communicated, the surgeon would have slowed down and waited for the prep to dry, and the anesthesia provider could have adjusted their practice to best support the patient. Waiting 3 minutes for the prep to dry would have all but eliminated the vapors from the alcohol in the solution and the area would not have been as flammable. The anesthesia provider could have addressed the oxygen saturation issue and possibly intubated the patient. This would have eliminated the concentration of oxygen around the incision site. Had all this information been discussed; a fire would almost certainly not have occurred. 

Conclusion

This is the reason why a fire risk assessment is completed before each case (and why we wait 3 minutes for alcohol-based preps to dry). It is to prevent a patient from being burned or going through a very unnecessary trauma while they are in our care.

References

1. Guideline for a safe environment of care. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc; 2024:165-196.

AORN Resources

Open access:

• Fire Safety Tool Kit | AORN

AORN members can access:

• Perioperative Fire Prevention and Mitigation - AORN Journal
• Steps to Take in the Event of an OR Fire - AORN Journal
• Recognizing fuel sources in the OR - AORN Journal
• Ensuring the Safe Use of High Alcohol–Based Skin Prep Solutions - AORN Journal
• Guideline Quick View: Environment of Care - AORN Journal

If your facility subscribes to eGuidelines+, you can access:

• Environment of Care Guideline | AORN eGuidelines+