AORN Fire Safety Tool Kit
Fire Prevention in the Perioperative Practice
Setting
Goals
After completing this learning activity,
perioperative team members will have increased
knowledge of fire safety in the perioperative
practice setting and of tools to promote fire
prevention, plan effective responses, and develop
evidence-based policies to protect perioperative
patients and personnel.
Learning Outcomes
After completing this activity, the participant will be
able to:
1. Identify the locations where a fire may occur
2. Identify the three components of the fire
triangle
3. Identify fire prevention interventions
4. Describe the fire risk assessment
Fire Facts
Estimated Frequency
• 200 to 240 per year in the United States
o 44% head, neck, or upper chest
o 26% elsewhere on the patient
o 21% in the airway
o 8% elsewhere in the patient
Patient Injuries
Of the 200 to 240 OR fires per year,
• 20 to 30 are serious and result in disfiguring or
disabling injuries
• 1 to 2 are fatal
Location
• Ambulatory surgery centers
• Hospitals
• Physicians’ offices
Patients
All patients
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Fire Triangle
Team Effort
• Nurses
• Surgical technologists
• Surgeons
• Assistants
• Environmental Services associates
• Administration team members
• Everyone else not mentioned
Fire Prevention Assessment
• Perform before the start of the procedure.
• All members of the team participate.
• Communicate this assessment during the “time
out.”
• Document the assessment in the patient’s record.
.
Fire Prevention Assessment
• Ignition sources that are present
• Fuels that are present
• The potential for the presence of an oxygen-enriched
environment
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Fire Prevention Assessment Tool
A. Is an alcohol-based prep agent or other volatile
chemical being used preoperatively? Y or N
B. Is the surgical procedure being performed above the
xiphoid process? Y or N
C. Is open oxygen or nitrous oxide being administered? Y
or N
D. Is an electrosurgical unit, laser, or fiber-optic light cord
being used? Y or N
E. Are there other possible contributors? Y or N
Ignition Sources
• Electrosurgical unit • Fiber-optic light
(ESU) • Defibrillator
• Argon beam • Electrical
coagulator equipment
• Power tools (eg,
drills, burrs)
• Laser
Controlling Ignition Sources:
Interventions
• Place the patient return
electrode on a large muscle
mass close to the surgical site.
• Keep active electrode cords
from coiling.
• Store the ESU pencil in a
safety holster when not in use.
Controlling Ignition Sources:
Interventions
• Do not use an ignition source to enter the bowel when it is
distended with gas.
• Keep the ESU active electrode away from oxygen or nitrous
oxide.
• Keep the active electrode tip clean.
• Use active electrodes or return electrodes that are
manufacturer-approved for the ESU being used.
• Use approved protective covers as insulators on the active
electrode tip, NOT red rubber catheter or packing material.
• Activate the active electrode only in close proximity to target
tissue and away from other metal objects.
Controlling Ignition Sources:
Interventions
• Inspect minimally invasive electrosurgical electrodes for impaired insulation;
remove electrode from service if not intact.
• Use “cut” or “blend” settings instead of coagulation.
• Use the lowest power setting for the ESU.
• Only the person controlling the active electrode activates the ESU.
• Remove the active electrode from the electrosurgical or electrocautery unit
before discarding.
Controlling Ignition Sources:
Interventions
• Use a laser-resistant endotracheal tube when using a
laser during upper airway procedures.
• Place wet sponges around the endotracheal tube cuff if
the surgeon is operating in close proximity to the
endotracheal tube.
• Use wet sponges or towels around the surgical site.
• Only the person controlling the laser beam activates the
laser.
• Have water or saline and the appropriate type of fire
extinguisher available.
Controlling Ignition Sources:
Interventions
• Place the light source in standby mode or turn it off
when not in use.
• Inspect light cables before use and remove them from
service if broken light bundles are visible.
• Select defibrillator paddles that are the correct size for
the patient.
• Use only manufacturer-recommended defibrillator
paddle lubricant.
• Place defibrillator paddles appropriately.
Controlling Ignition Sources:
Interventions
• Inspect electrical cords and plugs for integrity and
remove from service if broken.
• Check biomedical inspection stickers on equipment
for a current inspection date and remove the
equipment from service if not current.
• Do not bypass or disable equipment safety features.
• Follow manufacturer’s recommendations for use.
• Keep fluids off of electrical equipment.
Oxidizers
• Oxygen
• Oxygen-enriched environment
• Nitrous oxide
20
Controlling the Oxidizer:
Interventions
• Tent drapes to allow for free air flow.
• Keep the oxygen percentage as low as
possible.
• Use an adhesive incise drape.
Controlling the Oxidizer:
Interventions
• Inflate the endotracheal tube cuff with tinted
saline.
• Evacuate the surgical smoke from small or
enclosed spaces.
• Pack wet sponges around the back of the
patient’s throat.
• If oxygen is being used, suction the patient’s
oropharynx deeply before using the ignition
source.
Controlling the Oxidizer:
Interventions
• Inform the surgeon that an open oxygen source
is being used.
• Stop supplemental oxygen or nitrous oxide
before and during the use of an ignition source.
• Check the anesthesia circuits for possible leaks.
• Turn off the oxygen at end of each procedure.
Controlling the Oxidizer:
Interventions
• Oxygen delivery during head, face,
neck, and upper chest surgery:
o Do not use open delivery of 100% oxygen.
o Intubate or use a laryngeal mask airway if supplemental
oxygen needed.
o If oxygen is greater than 30% via open delivery, use 5 L to
10 L of air/minute under the drapes.
• Exceptions:
o Patient verbal response required during surgery (eg,
carotid artery surgery, neurosurgery, pacemaker insertion)
o Open oxygen delivery required to keep the patient safe
Fuels
• Patient • Linens
• Personnel • Head coverings
• Drapes • Shoe covers
• Gowns • Collodion
• Towels • Alcohol-based skin
• Sponges preparations
• Dressings • Human hair
• Tapes • Endotracheal tubes
Controlling Fuels:
Interventions
• Use moist towels around the surgical site when
using a laser.
• During throat surgery, use moist sponges as
packing in the throat.
• Use water-based ointment and not oil-based
ointment in facial hair and other hair near the
surgical site.
Controlling Fuels:
Interventions
• Prevent pooling of skin prep solutions.
• Remove prep-soaked linen and disposable
prepping drapes.
• Allow skin-prep agents to dry and fumes to
dissipate before draping.
• Allow chemicals (eg, alcohol, collodion,
tinctures) to dry.
• Conduct a skin prep “time out.”
CMS Regulations:
Alcohol-Based Skin Preps
• Policies and procedures must be in place to reduce
risk of fire.
• Personnel must be aware of these policies.
• Products are packaged for controlled delivery with
clear directions that must be followed.
• Documentation of implementation of fire prevention
practices must be present in the patient’s medical
record.
• Personnel must demonstrate practice of the
policies and procedures.
CMS Regulations:
Alcohol-Based Skin Preps
• The CMS inspector approaches you
and asks, “What is your facility doing
to reduce the risk of fires related to
alcohol-based skin preps?”
Summary
Steps for surgical fire prevention
1. Know the components
a) Ignition sources
b) Oxidizers
c) Fuels
2. Communicate
a) Fire risk assessment
References
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
October 28, 2018.
Clarke JR, Bruley ME. Surgical fires: trends associated with prevention efforts. Pa Patient Saf Advis. 2012;9(2):130-
135.
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.
Guideline for a safe environment of care. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
Guideline for safe use of energy-generating devices. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.
The End
