Minimizing Oxidizer Sources

Finally, let’s discuss how we can control oxygen sources and oxidizers inside the surgical area.  Oxidizer sources can be the ambient air and medical air (oxygen concentration is 21%), nitrous oxide and oxygen itself (creating concentrations well above ambient air). Concentrations of oxygen above 21% can permit items to ignite and burn at much lower ignition temperatures.  

o        Communication between the physician and the anesthesiologist is paramount. Staff should always question the need for open delivery of 100% oxygen concentration during facial surgery.   

o        Electrosurgical/electrocautery and supplemental oxygen should not be used simultaneously when possible. Medical air would be recommended for those patients who do not need supplemental oxygen. A pulse oximeter should be used in these situations to insure the oxygen saturation does not drop below 95%. Intermittent activation of either the electrosurgical/electrocautery device or supplemental oxygen is permitted but discouraged. It is recommended to stop the supplemental supply of oxygen for at least one minute prior to using a spark-producing device around the head and neck.  Oxygen can be restarted following the use of the spark-producing device.

o        Oxygen tubing found to be leaking should be replaced as quickly possible, and the oxygen should be shut-off between surgical cases. Oxygen to anesthesia machines should not be left on overnight.

o        Nitrous oxide poses the same hazard as oxygen and should be handled with the same precautions.

Summary

As we stated before, surgical fires can be complex problems for staff because they typically involve the patient.  However, if you can learn to control the heat, fuel, and oxygen sources in the surgical setting, then you have made great strides in preventing a tragedy.

In our next article, we shall discuss Surgical Fire Response.  A surgical fire can become very big almost instantaneously, which can challenge even the best educated and trained surgical staff. Once a surgical fire starts, it is capable of producing a large amount of hot toxic gases and smoke. A fast moving fire of this type will limit staff’s breathing and visibility. Appropriate response actions need to be taken immediately by every member of the surgical team if they are to have a successful outcome to this untoward event. Some of the items that we will be describing in this upcoming series of articles are:

o        Developing a surgical fire plan.

o        Conducting fire drills in the surgical setting.

o        Responding to fires outside the surgical setting.

o        Performing post fire investigation and reporting.

APPENDIX A

HEAT/IGNITION SOURCES

§         Electrosurgical and Electrocautery units

§         Lasers

§         Fiberoptic light sources

§         Defibrillators

§         Drills

§         Electrical equipment and cords

FUEL SOURCES

§         Prepping Agents (skin preparations, bone adhesives, aerosols, tinctures, degreasers (acetone, ether)

§         Ointments (petroleum jelly, paraffin)

§         Linens (drapes, scrubs, gowns, mattress pads, masks, hoods, caps, mattress/pillow, blankets)

§         Equipment/Supplies (plastic bags,  suction canisters, tubing, suture supplies, wire coverings, disposable packaging, breathing maintenance devices, blood pressure cuffs, evacuator hoses, instrument boxes, gloves)

§         Dressings (sponges, gauze, bandages, stockinettes, tapes)

§         Patients (body hair, fatty tissue, and gastrointestinal gases (hydrogen, methane).  

OXIDING SOURCES

§         Ambient air (oxygen concentration is 21%)

§         Medical air

§         Nitrous Oxide

§         Oxygen Enriched (oxygen concentration greater than 21%)

References:

AORN Journal, September 2003 Clinical Issues

AORN Guidance Statement: Fire Prevention in the Operating Room

ASA Newsletter, Danger from OR Fire Still a Serious Problem

ECRI, Only You Can Prevent Surgical Fires

ECRI, Surgical Fires: perioperative communication is to prevent this rare but devastating complication

ECRI, Medical Device Safety Reports, The Patient is on Fire!   A Surgical Fires Primer

Joint Commission on Accreditation of Healthcare Organizations, Sentinel Event Alert: Preventing Surgical Fires

Joint Commission on Accreditation of Healthcare Organizations, 2005 Ambulatory Care National Patient Safety Goals

Kimberly-Clark Health Care Education, Fire Safety in the Operating Room, Strategies for Keeping It Safe

Massachusetts Department of Public Health, Health Care Quality Safety Alert: Preventing Operating Room Fires during Surgery

MLMIC, Fire Safety in the OR

Valleylab, Institute of Clinical Education, Fire Prevention and Safety during Surgical Procedures