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alcohol prep that causes surgical fires; 5 percent of the fires are due to careless prepping. To calculate the rates at which fires occurred, the PPSA obtained the number of trips to the OR made in Pennsylvania hospitals and am- bulatory surgical facilities from the Pennsylvania Health Care Cost Con- tainment Council (PHC4). A surgical patient was a patient who had one or more operations during an admis- sion. If the same patient had a second admission, he or she was counted as a second surgical patient.

An Ounce of Prevention Worth a Pound of Cure

Photo by ECRI Institute Preventing OR Fires in Your ASC

Come to ASCA 2013 to learn how you can protect your ASC’s patients and staff. BY MARK E. BRULEY

Although rare, surgical fires continue to occur in hospitals and ASCs. They are dangerous to both patients and oper-

ating room (OR) staff. Implement- ing advisories on prevention, such as those proposed by the American So- ciety of Anesthesiologists, can help you prevent OR fires in your ASC. At ASCA 2013 in Boston, April 17–20, I am presenting “Preventing Surgical Fires” and discussing the rates at which these fires occur and best practices for preventing them. A panel of patient safety analysts

at The Pennsylvania Patient Safety Authority (PPSA) analyzed reports of surgical fires in its database and found that there were 70 fires be- tween 2004 and 2011 in Pennsylva- nia, or an average of 10 each year.


Scaling that number, we can come up with a number for the US, based on the number of surgeries and/or population. Based on the popula- tion model, that’s 245 fires a year, which is down from the 400 to 600 fires that we were estimating 10 years ago. Based on the number of surger- ies model, we estimate 220 fires a year, which also is down from prior estimates of 400 to 600 from 7 to 10 years ago. While the trend toward de- creasing numbers of these incidents is encouraging, more can be done to prevent fires in the OR. The PPSA analysis classified a

fire report as a surgical fire when it occurred on the sterile surgical field or in the airway and caused com- bustion of a surgical or anatomic substance. Most often it is oxygen buildup under the drape or sloppy

A coordinated OR team can elimi- nate surgical fire hazards and mini- mize the time between when a fire is set and when it is extinguished. Three elements contribute to a fire: a heat source, oxygen and a fuel. The surgeon usually controls the heat source, typically, an electrosur- gical unit, and can remove it from the field. The anesthesia provider usually controls the supplemental oxygen source and can minimize the risks from the oxidizer component, i.e., oxygen and nitrous oxide. The circulating nurse or scrub technician can manage the fuel element by cor- rectly applying alcohol-containing skin-prepping solutions, keeping ex- posed ends of fiber-optic light cords off the surgical field, and ensuring the availability of moist sponges, towels and aqueous solutions. The prevention procedure recom- mendations for surgical fires are the same for both hospital and ASC set- tings. Some of the initiatives to pre- vent surgical fires include: ■

2003: Joint Commission Sentinel Event Alert on preventing surgical fires;

The advice and opinions expressed in this article are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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