4572 Fire Safety In The Operating Roomguides.aurorapictures.com/4572.pdf · Kimberly-Clark Health Care Education 7 Introduction ÀiÃÊ ÊÌ iÊ «iÀ>Ì }ÊÀ Ê>ÀiÊÀi >Ì Ûi

4572

Fire Safety In The Operating

Room Strategies for Keeping It Safe

Study Guide

3

Fire Safety in theOperating Room _____________________________________________________________________

Strategies for Keeping It Safe

This program sponsored in part through an unrestricted educational grant provided by Kimberly-Clark Corporation

Video produced and distributed by:

Envision, Inc.644 West Iris DriveNashville, TN 37204

1-866-321-5066www.EnvisionInc.net

Kimberly-Clark Health Care Education 3

ACKNOWLEDGEMENTSWe would like to express our sincere appreciation to the following individuals:

Consultant

Jay Sommers, Ph.D.Director, Clinical and Scientific Documentation

Kimberly-Clark Health CareRoswell, GA

Clinical Advisors

Onita Cox, RNOperating Room Unit Manager

Southeastern Regional Medical CenterLumberton, NC

Wanda Faircloth, RN, BSN, MICN, CENCritical Care Educator


Susan Kerr, CRNAManager of Anesthesia Department


Kathleen B. Stoessel, RN, BSN, MSSenior Manager

Clinical EducationKimberly-Clark Health Care

Roswell, GA

Wava Truscott, Ph.D.Director

Scientific Affairs & Clinical EducationKimberly-Clark Health Care

Roswell, GA

Editorial and Research Support

Susan ShoemakeRoswell, GA

Copyright 2010 Envision, Inc. The following information is the property of Envision, Inc. and is protected by all U.S. Copyright laws. It must not be reproduced in any form without permission.

4


Fire Safety in the Operating Room


Table of Contents

Instructions for Continuing Education Credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Components of the Fire Triangle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Measures to Prevent Operating Room Fires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

In the Event of a Fire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Considerations for a Fire Safety Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Post Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Continuing Education Application . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Post Test Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Instructions for Continuing Education Credit

To obtain continuing education credit, the attendee shall:

Envision, Inc. 644 West Iris Drive Nashville, TN 37204 1-866-321-5066



6


Introduction

1

2

3

2,4

Objectives



Components of the Fire Triangle

2,5, 6

Ignition Sources

3

Lasers.

1

Electrocautery equipment.

7

1

Electrosurgical units.

8

8

Fiber-optic light sources, including endoscopes.

Defibrillators.

1

7



8

IGNITIONSOURCES

FUELSOURCES

OXIDIZERS


High-speed drills. 9

Electrical cords.

9

Fuel Sources

Patient. 9, 10

10 -1

1

1

Alcohol-based agents. ® ®

®

1, 8, 10

1

Drapes.

1, 10

2



11

1

Surgical Apparel. 10

Dressings. 10

12

Anesthesia components. 10

13

1

1

Other: petroleum-based ointments, surgical instrument covers, adhesives.2,10

Oxidizers

10

9



10


7

7

1

13

Measures to Prevent Operating Room Fires

Safety Practices When Using Ignition Sources

4

14

Inspect equipment before use.

8

Mount ESUs on movable, tip resistant stands.8

Practice cord safety.

8

9

8

8



Learn the proper method of turning the instrument on and off to avoid the creation of sparks.

9

Confirm power settings of an ignition source prior to activation.

8

Avoid selecting products that generate a static charge as this can produce dangerous sparks.

Remove body-piercing ornaments.

Avoid using ignition sources in the presence of flammable agents.

8

Avoid placing fluids on top of or next to equipment. 8

15

Ensure ESU pencils, lasers and high pressure flash lamps are immediately switched off or to stand-by mode when not in use.

Place appropriate active ignition sources in nonconductive, clean, dry safety holsters when not in use, as the holsters serve as insulators for the devices.

9,36

Remove contaminated ignition devices from the field or unplug them from the energy source to prevent accidental activation.

9, 15, 36

Ensure that ignition foot switches are safely positioned so that they cannot be accidentally activated.9

8

Avoid placing any high-energy ignition source on the drape as it may overheat.

Activate the light source only after it is connected to the scope, headlight, etc. 15

Use moist sterile towels or sponges when high-speed drills are used, as drills create friction and heat which could ignite a fire.

Apply the dispersing electrode or grounding plate to a clean, dry, muscular, hair-free area as close to the surgical site as possible. 9

Use the lowest possible power setting during electrosurgery and use short activations.99



12


Avoid insulating electrodes using anything except fire resistant materials.

9, 36

Use bipolar electrosurgery instead of monopolar electrosurgery for coagulation with open delivery of supplemental oxygen.2,36

Enclose high pressure flash, arc and filament lamps in appropriate housings.13

Safety Practices When Using Fuel Sources

Even though there are minimal flammability requirements for them, surgical gowns and drapes are frequently involved as a fuel source in operative room fires.

CPSC:

17

USA Today

NFPA:

ISO 11810-1: 18 In this test, a 20 watt

2



Shield the area around the surgical site with wet materials.

9

Avoid the use of plastic bags to cover patients. 15

Drape the patient only after all flammable prep solutions or aerosols are dry or completely evaporated.

15

9

Use water-based rather than petroleum-based ointments.

If an ignition source is used in or near the rectal area, consider placing a wet sponge pack in the rectum to reduce the chance of gas emissions.

19

Avoid rinsing gloves with alcohol to remove powder.

Remove all wrappers, used towels, saturated sponges and any other unnecessary flammable products from the immediate operative area.

Remove liquefied fat frequently by suction or other means in order to reduce the possibility of a flash fire.13

Avoid placing huck towels over lights to block part of the beam.

Safety Practices When Using Oxidizers

20

21, 22

Avoid the use of oxygen enrichment for patient ventilation when possible.2

15

Ensure that all oxygen delivery circuits are free of leaks.

1, 19



14


Arrange drapes to prevent the entrapment of anesthetic gases.

1, 9

During local or IV sedation cases in which supplemental O2 may be used, turn off supplemental oxygen at least 60 seconds prior to activating the ignition source.

9,15

Use laser resistant tracheal tubes if oxygen enriched ventilation is required.

13 9

Use evacuators under drapes to remove excess oxygen.15

In the Event of a Fire

The Human Response

3

3

1. Disbelief. 2. Inaction. 3. Reconsideration. 4. Action.

action.3

Actions to Take Should a Fire Occur

R A C E



15

37

The Surgical Team should:

The Anesthesia Provider should:

The Circulator should:



16


The Scrub Nurse/Surgical Technician should:

The Surgeon should:

The Profusionist of Surgical Assistants should:

Actions to Take After a Fire Occurs

3, 9

8

event.9



Considerations for a Fire Safety Plan

Make fire safety a part of the facility’s training program.

Assess all products that are used in the operating room for flammability.

15 13

Keep exit doors accessible and exit signs clearly visible.

15

Water can be used for extinguishing fires involving paper, cloth, rubber, wood and some plastics.2, 23

Establish a system to rapidly identify emergency fire equipment. 15

Make the appropriate fire extinguishers available. 2 2

2, 15

Learn how to use fire extinguishers.

25, 26

PULL AIM SQUEEZE SWEEP

Develop an evacuation plan.

Fire Risk Time Out.

2, 35, 36, 37



18


Know your individual responsibilities in the event of a fire or emergency evacuation.

Conduct a Failure Mode and Effects Analysis (FMEA).

Communicate effectively.

Summary



References 1.

British Journal of Anaesthesia 73: 847-56.

2. Health Devices. 2009

3. Journal of the American Association of Nurse Anesthetists

4.

5. The PNO Nurse Anesthetists Journal, 1,2,5.

6.

7. Today’s OR Nurse, 8-10.

8.

9.

10.

11.

12. Anesthesiology

13.

14.

15. Today’s OR Nurse 21:24-30.

16. Surgical Services Management

17.

18.

19.

20.

21. AANA Journal



20


22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35. AORN J.

36. AORN J.

37. Anesthesiology.



GlossaryActive electrode:

8

Antiseptic: 27

Combustion: 24

Current: 8

Diathermy: 28

Dispersive electrode: 8

Electrocautery: 2, 29

Electrosurgery: 2, 8, 29

Electrosurgical unit: 8

Fenestrated drape: 28

Fire: 24

Flame resistant: 30

Flame retardant: 30

Flammability: 24

Flammable: 24

Flammable gas: 10

Flammable liquid:

10

Flash point:

10

FMEA (Failure Mode and Effects Analysis):

31

Fuel: 24



22

High filtration masks: 32

Ignitable liquid: 10

Ignition: 24

Ignition source:

Insufflate: 28

Laser system: 32

Laser: 32

Light: 2

Nitrous Oxide:

24

Noncombustible:

Nonwoven material:

33

Operating room fire: 2

Oxygen Enriched Atmosphere (OEA): 2 2 2

2, 10

Root Cause Analysis (RCA): 34

Surface-fiber flame propagation: 2 2

2

Surgical fire: 2

Woven material: 33




Components of the Fire Triangle



24

Fuel Sources Ignition Sources

Lasers

Drills

Oxidizers

!!!!! activation.

!!!!!

!

!!!!!!

!!!!!

!!!!

!!

!!

!!!!!

!!!!




OR Fire Safety Checklist

Post-Test 1. A. B. C. D.

2.

A. B. C. D.

3. A. B. C. D.

4.

A. B. C. D.

5. A. B. C. D.

6. A. B. C. D.



26

7. A. B. C. D.

8. : A. B. C. D.

9. A. B. C. D.

10. : A. B. C. D.




Continuing Education ApplicationPlease print clearly and fill in all data to ensure accurate record-keeping.

Fire Safety in the Operating Room: Strategies for Keeping It Safe

LEARNING OBJECTIVES

1.

1.

3.

4.

CE CREDITS BY MAIL

Envision, Inc.Envision Inc., 644 West Iris Drive, Nashville, TN 37204.

D

TEST ANSWERS Circle only one choice for your answer to each question.

1. A B C D 6. A B C D

2. A B C D 7. A B C D

3. A B C D 8. A B C D

4. A B C D 9. A B C D

5. A B C D 10. A B C D



28


Evaluation FormPlease circle the number that reflects your extent of agreement with each statement:

Evaluate this program in each of the categories by using the following rating scale: Poor Satisfactory Good Excellent

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.



Post-Test Answers

1. D.

2. B. 21%.

3. D. All of the above.

4. A. Root Cause Analysis (RCA).

5. C. The Fire Triangle.

6. B. Immediate Action. 3

7. D. A & B.

8. A. Place huck towels over light frames to block part of the beam.

9. D. All of the above.

10. C. Make ABC or dry chemical fire extinguishers available for surgical fires. 2



30

Notes:




Documents

4572 Fire Safety In The Operating Roomguides.aurorapictures.com/4572.pdf · Kimberly-Clark Health Care Education 7 Introduction ÀiÃÊ ÊÌ iÊ «iÀ>Ì }ÊÀ Ê>ÀiÊÀi >Ì Ûi