Center for Improvement in Healthcare Quality Newsletter
April 2022

CIHQ-ARS Blog

Fire Safety in the Operating Room

By: William (Billy) Kinch
With all the potential risks within a hospital, they continue to maintain a safe environment. While this is primarily due to the great individuals who work in healthcare facilities, there are numerous codes and regulations which assist in ensuring safe environments. One location within a hospital that has a significant risk is the operating room. There is such a high risk that the NFPA developed safety precautions that hospitals are required to follow.
These precautions can be found in Chapter 15 of NFPA 99-2012 Healthcare Facilities Code. Here is a list of what those precautions are:
  • The hospital performs an evaluation of hazards that could be encountered during surgical procedures
  • That evaluation includes hazards associated with the properties of electricity, hazards associated with the operation of surgical equipment, and hazards associated with the nature of the environment
  • Periodic reviews of surgical operations and procedures are to be conducted with special attention given to any change in materials, operations, or personnel
  • The hospital shall establish fire prevention procedures
  • Medicaments and alcohol-based hand sanitizers, including those dispersed as aerosols, are permitted to be used in anesthetizing locations
  • Flammable liquid germicides or antiseptics used in anesthetizing locations, whenever the use of electrosurgery, cautery, or a laser is contemplated, shall be packed as follows:
    • In a nonflammable package
    • To ensure controlled delivery to the patient in unit dose applicators, swabs, and other similar applicators
  • Whenever the application of flammable liquid germicides or antiseptics is employed in surgeries where the use of electrosurgery, cautery, or a laser is contemplated, time shall be allowed to elapse between application of the germicide or antiseptic and the following:
    • Application of drapes, to allow complete evaporation and dissipation of any flammable vehicle remaining
    • Use of electrosurgery, cautery, or a laser, to ensure the solution is completely dry and to allow thorough evaporation and dissipation of any flammable vehicle remaining
  • Any solution-soaked materials must be removed from the operating room prior to draping or use of electrosurgery, cautery, or a laser.
  • Pooling of flammable liquid germicides or antiseptics are to be avoided. If pooling occurs, excess solution is required to be wicked, and the germicide or antiseptic shall be allowed to completely dry.
  • A preoperative “time out” period is required to be conducted prior to the initiation of any surgical procedure using flammable liquid germicides or antiseptics to verify the following:
    • Application site of flammable germicide or antiseptic is dry prior to draping and use of electrosurgery, cautery, or a laser
    • Pooling of solution has not occurred or has been corrected
    • Any solution-soaked materials have been removed from the operating room prior to draping and use of electrosurgery, cautery, or a laser
  • Whenever flammable aerosols or antiseptics are employed, sufficient time is allowed to elapse between deposition and application of drapes to allow complete evaporation and dissipation of any flammable vehicle remaining.
  • Health care facilities must establish policies and procedures outlining safety precautions related to the use of flammable liquid or aerosol germicides or antiseptics used in anesthetizing locations whenever the use of electrosurgery, cautery, or a laser is contemplated.
  • There must be procedures for emergencies developed.
  • These procedures must include alarm actuation, evacuation, and equipment shutdown procedures and provisions for control of emergencies that could occur in the operating room, including specific detailed plans for control operations by an emergency control group within the organization or the fire department.
  • Emergency procedures are established for controlling chemical spills
  • Emergency procedures are established for extinguishing drapery, clothing, or equipment fires
  • New personnel, including physicians and surgeons, must be taught general safety practices for the area and specific safety practices for the equipment and procedures they will use.
  • Continuing education and supervision is provided
  • Incidents must be reviewed monthly.
  • Procedures are reviewed annually.
  • Fire exit drills are conducted annually or more frequently if required by building codes, the Life Safety Code, or fire codes.
These requirements are reviewed during inspections of the hospital to ensure they are maintaining safe environments. These procedures will give the organization the best possibility to not have fire emergencies during surgical procedures.
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