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 Surgical Fires In June of 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued a Sentinel Event Alert bulletin in an effort to bring awareness in preventing surgical fires. According to the bulletin, "...there are approximately 100 surgical fires each year, resulting in up to 20 serious injuries and one or two patient deaths annually. An oxygen-enriched atmosphere was a contributing factor in 74 percent of all cases.
The Association of Perioperative Registered Nurses (AORN) has a position statement for its members. Click here to read it. Below is a primer on surgical fires, excerpted from the non-profit health agency ECRI (www.ecri.org).  Most people have heard of the fire triangle: heat, fuel, and oxidizer. When these three components come together in the proper proportions, a fire--the rapid chemical reaction of fuel with oxygen, resulting in the release of heat and light energy--is bound to occur. Diminish or remove any element of the triangle, and a fire can be prevented or extinguished.Each side of the triangle contains obvious (and some not-so-obvious) components that are commonly found in the OR environment. Each member of the surgical team controls a specific side of the triangle: surgeon, heat sources; nurse, fuels; anesthesiologist, oxidizers. By understanding the fire triangle and how to properly manage its components, the surgical team can prevent fires.  Heat and ignition sources. Heat input from a variety of sources increases the oxidation rate of a fuel-oxygen mixture until combustion occurs. In addition to the overhead surgical lights, some of the heat sources found in the OR are defibrillators; electrosurgical or electrocautery units (ESUs, ECUs); heated probes; drills and burs; argon beam coagulators; fiberoptic light sources and cables; and lasers used with the free-beam (bare-fiber) method or with contact tips or fibers. These sources produce temperatures from several hundred to a few thousand degrees Fahrenheit, enough to ignite most fuels, including most drapes. In addition, incandescent sparks can be produced by ESUs or high-speed drills and burs; lasers can also cause sparks when the energy hits instruments or the laser fiber becomes damaged. These sparks, or even glowing embers of charred tissue, can provide enough initial heat to ignite some fuels, especially in oxygen-enriched atmospheres (OEAs).
Fuels. A fuel is anything that can burn, including almost everything that comes in contact with patients, as well as the patients themselves. As shown in the "Fuels Commonly Encountered in Surgery" table below, fuels abound in the OR; note that, in addition to the many items that are generally known to burn, many other items that are not generally thought of as flammable are listed. Some prepping agents and a few ointments required during surgery are volatile and extremely flammable, more so than many other fuels. For example, liquid alcohol from a wet, dripping prep can pool under the patient and generate vapors beneath the drapes for quite some time. Concentrated alcohol vapors trapped under drapes or above areas still wet with alcohol can be easily ignited by heat or sparks (see "Proper Prepping Techniques," below). Open bottles or basins containing volatile solutions (e.g., alcohol from suture packs, acetone degreaser) should be closed or removed from the sterile area as soon as possible after use. Under the right conditions, some surgical ointments can burn. For example, petroleum-based ointments used in an OEA will ignite when enough heat is present to cause vaporization. These materials must vaporize and mix with oxygen to allow ignition. Globs of ointment are not easy to ignite because their mass absorbs considerable heat before vaporizing. Thin layers, however, have a low mass per area and need less heat to cause vaporization; thus, they are more ignitable. In contrast, water-based lubricants, such as K-Y Jelly, are mostly water and will not burn; heat simply vaporizes the water in the lubricant, cooling the area. In fact, water-based lubricants can be used to coat hair to make it fire resistant.  |
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Also, for a few seconds after deactivation, a heated ESU or ECU probe tip, fiberoptic cable tip, or laser contact tip can retain enough heat to melt plastics or ignite some fuels. While these devices must be in contact with a material to heat it, a laser can heat a fuel from a few centimeters to several meters away. A fiberoptic light source may take a minute or so to heat a drape to the point of combustion, while a laser can cause almost instantaneous ignition. By ensuring that these heat sources are not directed toward or allowed to come in contact with fuels, OR staff can prevent fires.