ANALYSISAND APPLICATION OF CLINICAL PRACTICE GUIDELINES: SUMMARY OF “FIRESAFETY IN THE OPERATING ROOM”
Analysisand Application of Clinical Practice Guidelines: Summary of “FireSafety in the Operating Room”
Thispaper offers a summary of the article “Fire Safety in the OperatingRoom: Strategies for Keeping it Safe” by Knowledge Network. Indeed,the article contains comprehensive information of fire safety withinthe context of operating rooms in hospitals. A look at theinformation reveals that an occurrence of fire within the operatingrooms is a serious issue that requires all-inclusive measures ofprevention initiatives. There are several causes of fires inoperating rooms, which are indicated in the article. These includebut are not limited to lasers, electrical sparks, cleaning solutions,and oxygen. Once there is ignition, fire quickly spreads when exposedto dares, or linens that are used in operating rooms. Even so, thearticle posits that prevention of fires in operating rooms can beachieved if the medical professionals follow the sets of guidelinesthat have been developed on the subject matter.
Tobegin with, it is important for the members of staff to be familiarwith their designated roles in terms of fire prevention. They oughtto comprehend the different components of fire outbreaks. Thesecomponents, according to the article, include oxidizers, ignitionsources, and fuel. In any case, wherein these components get underclose contact, there is risk for a fire outbreak within the operatingroom (OR). For this reason, the main goal in fire prevention remainsthe altering of a single, or more of the components with a purpose ofensuring combustion cannot occur. Recommendations have been made tofacilitate the open delivery of oxygen in cases where surgicalprocedures are conducted on the head, or other parts of the upperbody like the chest and neck. Supplemental oxygen is recommended foruse in such operations. In all cases, however, the OR staff shouldensure the implementation of preoperative time-out for the purposesof assessing fire risk.
Itis important to note, as mentioned that, each member of the OR staffhas a role in the management of the fire triangle. A circulatingnurse in the OR usually supplies the fuel sources of fire. The mainexamples of the fuel sources are alcohol, and the alcohol-basedsolutions for skin preparations, or disinfection, petroleum-basedproducts, and aerosols. All of the OR personnel ought to ensure thatthe fuels are given time to dry, do not pool, and are not in contactwith patients by means of saturated towels.
Othersources of fire are under frequent control of surgeons. These includebut are not limited to electro cautery equipment, lasers, fiber opticlight sources, defibrillators, and electrosurgical units. In terms ofoxidizers, it is important to note that ambient air (containing 21%oxygen) can facilitate ignition, and spread of fire and such isconsidered an oxidizer. All the same, the atmosphere inside the OR isconsidered as being oxygen rich, if it has more than 21% of oxygen.Indeed, in an oxygen rich atmosphere, fire develops and spreads morequickly. A key element of oxidizing the OR is the anesthesia that hasoxygen, or rather nitrous oxide. Other items with capacity ofemitting oxidant gas include the tracheal tubes, delivery masks, andthe breathing tubes. The tubes and masks are considered “open” incases where oxidant gases can easily escape to the outsideenvironment. To enhance the roles of OR personnel in fire prevention,it is recommended that they engage in a series of drills. Even so, itis noted in the article that high-speed drills involve risks of firecreation. These activities can easily create incandescent sparks thatcould ignite fuels, particularly within the contexts of an oxygenrich atmosphere. The mentioned electrical sparks are often a resultof the frayed or cut electrical cords. The article notes that whilesome sources of ignition require direct contact with a fuel to ignitefire, others can manage to create combustion from a distance, even anumber of yards. For this reason, it is vital for OR personnel toensure that ignition sources remain isolated, and or confined.
Nevertheless,it is interesting to note, as indicated in the article, that patientsform a fuel source that is often overlooked by many OR personnel. Onecannot decline to note that the body hair catches fire with muchease. It is hence, observed as a fuel source that can contribute topropagation of fire in the OR. For this reason, OR personnel arerequired to be careful, especially in cases where surgical operationsare conducted on the head or neck, and an oxygen rich atmosphere isrequired. Another point of consideration is that the intestinaltracts of people produce flammable gases from time to time. For thisreason, perineal emissions ought to be considered as fuel sources ofignition that can easily ignite, if they get in contact with a spark.Common flammable gases are hydrogen and methane. In cases wherepatients are administered a preoperative enema that has mannitol,production of hydrogen is increased within their bodies. In suchcases however, the risk of combustion is reduced by insufflating thepatient with carbon dioxide. What is more is that there is anapparent risk of perforation of the bowel by electrical tools used inlaparoscopic surgical procedures. In such cases, carbon dioxide gasis usually insufflated into the patient’s peritoneal cavity. Assuch, OR personnel are required to observe guides of dealing withelectrical equipment for purposes of preventing surgical fires.
Incases of fire outbreaks, OR personnel are required to makeappropriate use of tools like fire extinguishers. These tools areoften used in cases where the fire cannot be easily controlled byother measures like smothering with damp towel(s), or pouring of asaline solution. In extinguishing the fire, it is required that theoxygen supplies in the room are well controlled or cut off, otherelectrical equipment have to be turned off as well. Reporting of theincident is also required basing on specific a codename for fireoutbreaks. For the OR employees, patient safety is supposed to comefirst at all times.
Overall,the OR personnel have to ensure minimization of presence of the FireTriangle components. The article notes that majority of OR fires thathave been reported so far, involved surgical equipment of lasers,electrosurgical units, and fiber optic. As such, it is very importantthat perioperative teams ensure that product-specific guidelines arefollowed to ensure proper handling of surgical equipment. The articleoffers specific guides of using surgical equipment. First, the ORstaff should ensure to inspect surgical equipment before commencementof use. Maintenance, and or calibration stickers have to be checkedbefore equipment is put to use. If any equipment is damaged, it hasto be removed from the OR straightaway, and be taken for repair.Other safety features like activation sound indicators and lightapparatus ought to be checked before a surgical operation is started.In addition, the ESUs have to be finely mounted on the movable standsthat are tip resistant. The cords that are used in the surgery shouldalso be long, uncoiled, and flexible as required, to reduce tension,the risks of fraying, and disconnection during surgery. Any cordsthat may be cut, melted, separated, or cracked have to be removed,and sent for repair. It is also important to ensure that the cordsthat are on the ground are not on traffic paths within the room asthis could cause tripping of the personnel.
Asidefrom ensuring proper mechanisms of switching equipment on and off,the article indicated that OR staff have to ensure that the powersettings of any electrical equipment are correct before putting themto use. These settings should be in line with the manufacture guides,and or recommendations, which often consider the size and conditionof a given patient. What is more is that the OR personnel shouldavoid the use of electrical equipment that generate and emit staticcharges, which are a dangerous source of sparks and ignition.Body-piercing objects, or ornaments should also be removed, sincethey may conduct electrical energy. In cases where such objects arenot removed, the OR staff should ensure to insulate them by means ofelements like insulative tapes.
Again,there is a great need of ensuring fuel sources are kept away fromelectrical equipment. Some other equipment like lasers, flash lamps,and ESU pencils should be switched off whenever they are not in use.Additionally, equipment with ignition capability needs to be wellkept in dry, clean, and nonconductive holsters, away from thepatient, when they are not in use. The article goes ahead to outlineother measures of ensuring safety within the OR that are notindicated in this summary. It indicates that human response remainsimportant in the event of a fire, wherein people engage in phases ofdisbelief, inaction, reconsideration, and action. The articleoutlines that the actions to be taken in the event of a fire shouldfollow the “RACE” model, which involves Rescuing (of person onfire), Alarm, Confine (of fire) and Extinguishing and evacuating thearea.
References
KnowledgeNetwork. (2011). Fire Safety in the Operating Room: Strategies forKeeping it Safe. Retrieved Online fromhttp://www.aurorapictures.com/site/files/PDF/4572.pdf