Mac’s Safety Space: Safety first: Managing surgical fire risks in the operating room

In general, I think it can be rather instructive when (and to what degree) our friends in Chicago modify an existing Sentinel Event Alert, particularly one that relates to the management of risks in the physical environment. And this latest update, as represented by Sentinel Event Alert 68, is certainly no exception. As a going concern, this is probably among the more straightforward undertakings in that the risks to be managed are very well-established, yet it seems likely that surgical fires occur more often than just about any other conflagration event in healthcare (kitchen fires are probably in the mix in terms of frequencies, but the patient harm factor is—hopefully—significantly less). All this adds up to what will probably be an increased focus during the next survey cycle, and while this has been bubbling around for a while, I realize that it might be time to take a step back and look at some of the particulars. I know this is ground we’ve already covered, but sometimes looking back helps us move forward.

While surgical fires are relatively rare, the risks inherent in the  “intersection” of oxygen, heat sources, and combustible materials can result in catastrophic incidents to patients and, indeed, anyone else in the procedural environment. And the presence of each of the elements in the fire triangle can very much be characterized as abundant, so the risks have to be managed for every case and every patient. And it all starts with having a hardwired process for managing those risks, such as the following:

  • The foundation of fire risk management begins with a thorough preoperative assessment—identification of potential ignition sources and evaluation of the patient’s risk factors are essential to preparing a detailed surgical fire risk assessment.
  • The fire risk assessment (which really has to be a standard part of the preop preparation activities)  should take into account the patient’s characteristics, the procedure being performed, and the specific fire risks involved in the procedure.
  • Once the assessment is completed for the procedure, open and effective communication with the members of the surgical team is critical. Everyone must be aware of the assessment, the roles each person plays in preventing fires, and the actions to take if a fire does occur.
  • When it comes to the elements of the fire triangle—oxygen, heat source, materials—minimization of higher risk conditions is definitely the way to go. Use fire-resistant surgical drapes and materials whenever possible. Maintain strict safety protocols when using electrosurgical devices, lasers, and other heat sources. Be cautious when administering supplemental oxygen during the procedure; minimize flow rate and ensure that oxygen is delivered as close to the patient’s airway as possible to reduce the risk of creating an increased oxygen-enriched atmosphere.
  • Implement a regular program of surgical fire education and drills with the surgical team; simulating a fire scenario can help the team respond more effectively in the event of an actual fire event. Don’t forget to include awareness of the provisions for surgical fire safety in NFPA 99-2012; section 15.13 Fire Loss Prevention in Operating Rooms; this is where all these elements are codified and mandated through the CMS code adoption process. Effectively managing surgical fire risks is a regulatory requirement.

The management of surgical fire risks is a vital component of patient safety in the operating room and other procedural areas in which fire risks are inherent. While these incidents are infrequent, the potential consequences are severe, making it imperative for healthcare professionals to be vigilant and prepared. By understanding the risk factors, conducting thorough preoperative assessments, and adhering to safety protocols, standards, and guidelines, the surgical team can create a safer environment for both patients and healthcare providers. In the operating room, safety should always be the top priority. Sentinel Event Alert 68 should serve only as a reminder—if you think it’s a call to action, it might be too late. There are procedures occurring in your organization every day—probably right now. If these safeguards aren’t already in place…

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at