OR Fire Safety
Heat + Fuel + Oxidizers = Fire
Where:
Heat = electro surgery probes, electrocautery pencils, lasers and fiber optic light sources
Fuel = preps, drapes, gauze, mattresses, tubes and body hair
Oxidizers = oxygen, nitrous oxide
Good OR Fire Prevention Practices
- Keep oxygen as low as possible, preferably under 30 percent. Where oxygen
is controlled through a tube it is often safer. Patients do get burnt without
an oxygen rich environment but not as seriously.
- Allow preps to completely evaporate before the team drapes the patient,
administers oxygen or turns on the electro surgery device or laser. Make sure
preps haven’t pooled under patients or towards the drape. Soak up excess with
sterile towel and remove it.
- Don’t allow oxygen to get trapped under the drape. There’s no such thing
as a non-flammable drape. Several drapes that are flame-resistant are plastic
coated and shrink away. When exposed to heat and oxygen over 80%, the plastic
melts off and can singe the patient. Use ignition resistant (such as polyproplyene) drapes.
Instead of cauterizing a wound while a patient is receiving oxygen, hold your finger on it for 30 seconds, and then give air. Turn off oxygen before cauterizing the wound electronically. Place electro surgery pencils and other tools in holsters when not in use and not on patient.
- Do not use “Blow-by” oxygen.
- Know how to put out fires and where the exits are. Make sure nurses have
water basins in reach during laser surgery. Understand how to remove burned
material from patient and how and where to evacuate patients in case of a fire.
- Keep in mind for procedures that require tracheal tubes, the polyvinyl chloride tubes are extremely combustible. There have been cases where lasers ignited a tracheal tube, ultimately killing the patient.
OR Fire Suppression Options
- If you can remove what is burning on the patient then remove it and put
it in a water basin. For example, items such as drapes or surgical gowns.
- Fire extinguishers are of little value to fires on the operating tables
because by the time staff gets an extinguisher; the patients would already be
severely injured from the fire. Should you decide to use of fire extinguisher
you should be aware of their consequences.
- Dry Chemical Fire Extinguishers “ABC” or “BC”: Dry chemical extinguishers leave residue on the patient or medical device that could corrode the equipment, infect the wound or cause lung irritation.
- Carbon Dioxide Fire Extinguishers “BC”: CO2 extinguishers are the preferred extinguisher in the OR’s since they do not leave a residue. Although at close range they can cause frostbite on exposed skin. If you use a sweeping motion when discharging the extinguisher you should eliminate the threat of prolonged CO2 exposure. While CO2 is not rated for class A fires, you should be able to extinguish items such as surgical drapes and gowns because they are very thin and will not retain heat or promote re-flashing, which are the usual problems with Class A fires.
- Water Mist Extinguishers “ABC”: Water mist extinguishers use distilled water that lacks organic growth making it safer near surgical incisions. The water in the extinguisher is not sterile so there still is a concern about infections. The spray passed Underwriters Laboratories’ test criteria or Class C fires. There is a concern about the water pooling near electrical equipment and creating an electrocution hazard.
- Pressured Water Fire Extinguisher “A”: These extinguishers are under pressure and discharge the water with a relatively significant force. Since the water is being discharged in a straight stream there is an electrocution concern. These extinguishers are not listed for Class C fires. The water in the extinguisher is not sterile so there is also a concern about infections.
- Fire blankets could be used but there is a concern if the fire starts under a surgical drape where oxygen tubes supply the patients. This configuration could create an oxygen-enriched atmosphere that cannot be smothered and could actually bring the fire physically closer to the patient.
QUESTIONS? Contact the EH&S Fire Marshal's Office at (585) 275-3243 or e-mail EH&S Questions
This page last updated 9/20/2004. Disclaimer.
