Transcript Fire prevention slideshow - Association of periOperative

Fire Prevention
in the Perioperative Practice
Setting
2013 AORN Fire Safety Tool Kit
Overview and Goal
• Recent statistics indicate the numbers of surgical fires
reported have increased from approximately100-200
fires per year to over 550 surgical fires per year.
• The goal of this learning activity is to educate
perioperative RNs about fire safety in the perioperative
practice setting. Proactive tools to promote fire
prevention, plan effective responses, and develop
perioperative evidence-based policies to protect
perioperative patients and personnel will be discussed.
Objectives
After completion of this continuing nursing
education activity, the participant will be able to:
1. Identify the three components of the fire
triangle.
2. Identify fire prevention interventions.
3. Identify the steps to extinguish a fire in
perioperative areas.
4. Identify evacuation routes.
Objectives
5.
6.
7.
8.
Describe the Fire Risk Assessment.
Identify the types of fire extinguishers
recommended for use to extinguish an fire
that occurs in the perioperative area.
Explain the “PASS” technique.
Review the “RACE” technique.
Fire Facts
• Estimated Frequency
– 550-650 per year in the U.S.
• 44% on head, neck or upper chest
• 26% elsewhere on the patient
• 21% in the airway
• 8% elsewhere in the patient
Locations
Surgical Fires Occur:
ANYWHERE
• Ambulatory Surgery Centers
• Physicians’ Offices
• Hospitals
Patient Injuries
• Of the 550-650 fires per year in the
U.S.
–20 to 30 are serious and result in
disfiguring or disabling injuries
–1 to 2 are fatal
Surgical Fires
Reported by Procedure
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Tracheotomy
Oral surgery
Tonsillectomy
Facial surgery
Infant surgeries
Pneumonectomy
Cervical conization
Cesarean section
High Risk Procedures
• Surgical procedures above the xiphoid
process and in the oropharynx carry the
greatest risk
– Lesions removal on the head, neck, or face
– Tonsillectomy
– Tracheostomy
– Burr hole surgery
– Removal of laryngeal papillomas
Contributing Factors
Ignition Sources
• 70% Electrosurgical units,
• 20% Other heat sources
– Hand-held battery operated
devices
– Fiberoptic light sources
– High-speed burrs
– Defibrillators
• 10% Lasers
Oxidizers
• 75% Oxygen-enriched
atmospheres.
Fuel
• 4% Alcohol-based
surgical prepping agents.
Fire Triangle
Ignition Sources
• Electrosurgical unit
• Fiber optic light
• Argon beam
• Defibrillator
coagulator
• Electrical equipment
• Power tools( e.g. drills,
burrs)
• Laser
Controlling Ignition Sources:
Interventions
• Place the patient return electrode on a large muscle mass close to
the surgical site
• Keep active electrode cords from coiling
• Store the ESU pencil in a safety holster when not in use
• Keep surgical drapes or linens away from activated ESU
• Moisten drapes if absorbent towels and sponges will be used close
proximity to the ESU active electrode
Controlling Ignition Sources:
Interventions
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Do not use an ignition source to enter the bowel when distended with gas.
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Keep ESU active electrode away from oxygen or nitrous oxide.
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Keep the active electrode tip clean
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Use active electrodes or return electrodes that are manufacturer approved for the ESU
being used
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Use approved protective covers as insulators on the active electrode tip. NOT red rubber
catheter or packing material
•
Activate active electrode only in close proximity to target tissue and away from other
metal objects
Controlling Ignition Sources:
Interventions
• Inspect minimally invasive electrosurgical electrodes for
impaired insulation; remove electrode from service if not
intact
• Use cut or blend settings instead of coagulation
• Use lowest power setting for the ESU
• Only the person controlling the active electrode activates
the ESU
• Remove active electrode from electrosurgical or
electrocautery unit before discarding
Controlling Ignition Sources:
Interventions
• Use a laser-resistant endotracheal tube when using laser
during upper airway procedures
• Place wet sponges around the tube cuff if operating in close
proximity to the endotracheal tube
• Use wet sponges or towels around the surgical site
• Only the person controlling the laser beam activates the laser
• Have water and the appropriate type fire extinguisher
available
Controlling Ignition Sources:
Interventions
• Place the light source in standby mode or turn off when not in
use
• Inspect light cables before use and remove from service if
broken light bundles are visible
• Select defibrillator paddles that are correct size
• Use only manufacturer recommended defibrillator paddle
lubricant
• Place defibrillator paddle appropriately
Controlling Ignition Sources:
Interventions
• Inspect electrical cords and plugs for integrity
and remove from service if broken
• Check biomedical inspection stickers on
equipment for a current inspection date and
remove from service if not current
• Do not bypass or disable equipment safety
features
• Follow manufacturer’s recommendations for use
• Keep fluids off electrical equipment
Oxidizers
• Oxygen
• Oxygen enriched environment
• Nitrous oxide
Controlling the Oxidizer
Interventions
• Tent drapes to allow for free air flow
• Keep oxygen percentage as low as possible
• Deliver 5 L to 10 L/min of air under drapes
• If >30% concentration required, intubate or use laryngeal mask
airway
• Stop supplemental O2 or nitrous oxide 1 min. before using ignition
source
• Use an adhesive incise drape
Controlling the Oxidizer: Interventions
• Inflate endotracheal tube cuff with tinted saline
• Evacuate surgical smoke from small or enclosed
spaces
• Pack wet sponges around the back of the throat
• If O2 is being used, suction the oropharynx deeply
before using ignition source
• Check anesthesia circuits for possible leaks
• Turn off O2 at end of each procedure
Fuels
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Patient
Personnel
Drapes
Gowns
Towels
Sponges
Dressings
Tapes
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Linens
Head Coverings
Shoe covers
Collodion
Alcohol-based skin
preparations
• Human hair
• Endotracheal Tubes
Controlling Fuels: Interventions
• Use moist towels around the surgical site
when using a laser
• During throat surgery, use moist sponges
as packing in the throat
• Use water based ointment and not oil
based ointment in facial hair and other hair
near the surgical site
Controlling Fuels:
Interventions
• Prevent pooling of skin prep solutions
• Remove prep-soaked linen and disposable
prepping drapes
• Allow skin-prep agents to dry and fumes to
dissipate before draping
• Allow chemicals (e.g., alcohol, collodion,
tinctures) to dry
• Conduct a skin prep “time out”
CMS Regulations
Alcohol-Based Skin Preps
• Policies and procedures must be in place to reduce
risk of fire
• Personnel must be aware of these policies
• Products are packaged for controlled delivery with
clear directions that must be followed
• Documentation of implementation of fire prevention
practices must be present in the patient’s medical
record
• Personnel must demonstrate practice of the policies
& procedures
CMS, State Operations Manual , Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for
Hospitals http://cms.gov/manuals/Downloads/som107ap_a_hospitals.pdf
CMS Regulations
Alcohol-Based Skin Preps
• The CMS inspector approaches you and
asks “What is your facility doing to reduce
the risk of fires related to alcohol based
skin preps?”
ECRI Revised Recommendation
Fire prevention is a team effort!
• Perform a Fire Risk Assessment
• Surgeon must be made aware of open O2
use
• Stop supplemental O2 before & during use
of ignition source
ECRI. New clinical guide to surgical fire prevention. Health Devices. 2009;38(10):314-332.
ECRI Recommendations
• Oxygen delivery during head, face, neck, and upper chest
surgery:
– Do not use open delivery of 100% oxygen
– Intubate or use laryngeal mask airway if supplemental
oxygen needed
– If O2 is greater than 30% via open delivery, use 5-10 L of
air /min under the drapes
• Exceptions:
– Patient verbal response required during surgery (e.g.,
carotid artery surgery, neurosurgery, pacemaker insertion)
– Open oxygen delivery required to keep the patient safe
ECRI. New clinical guide to surgical fire prevention. Health Devices.
2009;38(10):314-332.
Fire Risk Assessment
• Perform before start of procedure
• All members of the team participate
• Communicate this during the “Time
Out”
• Document in the patient record
ECRI. New clinical guide to surgical fire prevention. Health Devices. 2009;38(10):314-332
.
Fire Risk Assessment Tool
A. Is an alcohol-based prep agent or other volatile
chemical being used preoperatively? Y or N
B. Is the surgical procedure being performed
above the xiphoid process? Y or N
C. Is open oxygen or nitrous oxide being
administered? Y or N
D. Is an ESU, laser, or fiber-optic light cord being
used? Y or N
E. Are there other possible contributors? Y or N
Types of Fires
• ON the patient
• IN the patient
– Includes airway fires
• ON or IN a piece of Equipment
Fighting Fires On A Patient
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Announce the fire
Attempt to extinguish with water or saline
Remove burning materials from patient
Extinguish on floor
Turn off oxygen source
Obtain fire extinguisher as last response
Save all involved materials
Fighting Fires
Involving an Endotracheal Tube
• Announce the fire.
• Collaborate and assist the anesthesia professional
with:
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disconnecting and removing the breathing circuit
turning off the flow of oxygen
pouring saline or water into the airway
removing the endotracheal tube and any segments of the
burned tube
– examining the airway
– re-establishing the airway
Fighting Fires On or In A Patient
• Assess the surgical field for a secondary
fire on the underlying drapes or towels
• Assess the patient for injury
• Report injuries to the physician
• Document assessment
• Activate alarms if necessary
• Notify appropriate chain of command
Fighting Fires
On or In Equipment
• Communicate the presence of the fire to team members
• Disconnect equipment from its electrical source
• Shut off electricity to the piece of equipment at the
electrical panel
• Shut off gases to equipment, if applicable.
• Assess fire size and determine if equipment can be
removed safely or if evacuation is needed
• Extinguish fire with extinguisher, if appropriate
• Activate alarms, if necessary
• Notify the appropriate personnel
How To Extinguish A Fire
using Solution
• Use a nonflammable liquid such as saline
or water
• Aim at base of fire
• Remember: drapes may be impermeable
How To Smother A Fire
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Hold towel between fire and patient airway
Drop one end of towel toward head
Drop other end of the towel over fire
Sweep hand over towel
Raise the towel
Keep your body away from fire
DO NOT PAT
How to Handle a fire
in other parts of the building
• Charge nurse should notify team
members where procedures are in
progress
• Do Not Start elective cases
• All personnel should prepare to
evacuate
Fire Blankets
Not for Patient Fires!
Fire Blankets are Not Recommended!
• Fire may be sustained by O2 delivered to
the patient
• Placing a Blanket
– may trap fire next to or under the patient
– May displace instruments
– May burn in oxygen-enriched atmospheres
NFPA Fire Classification*
Class A: wood, paper, cloth, and most plastics
(eg, combustible materials)
Class B:
flammable liquids or grease
Class C: energized electrical equipment
Combination:
ABC, AC
* NFPA = National Fire Protection Association
Recommended Fire Extinguisher
• ECRI : Class A, B, C
• NFPA: Class A, B, C, or AC
• Check with the authority having jurisdiction
(e.g., local fire marshal)
Fire Extinguisher Use
“PASS”
P Pull the pin
A Aim nozzle at the base of the fire
S Squeeze the handle
S Sweep the stream over the base
of the fire
Shutting Off Gases
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Find the Valve Location
Be familiar with Valve Operation
Determine When to shut off gases
Determine Who can shut off
gases
Sprinklers and
Smoke Detectors
• Sprinkler
– activated by Heat
–must be unobstructed
• Smoke Detector
–sounds alarm
Evacuation Types & Areas
• Who determines when to Evacuate
• Lateral, Horizontal, or Vertical
Evacuation
• Fire Doors
• Smoke Compartments
• Evacuation floor plan maps
Evacuation Steps
Use “RACE”
R
A
C
E
Rescue
Alarm
Confine
Evacuate
Responsibilities In A Fire
Depends on:
– Facility
– Time
– Personnel present
– Size of fire
– Location of fire
Facility
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Office based
Small ambulatory surgery center
Large ambulatory surgery center
Small hospital
Large hospital
Teaching hospital
University medical center
Time
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Normal business hours
Evenings
Weekends
On-Call hours
Personnel Present
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Circulating RN
Scrub Person
Anesthesia professional in the room
Surgeon
Supervising anesthesia professional
Anesthesia assistant
First Assistant (e.g. RNFA, surgical assistant)
Charge RN
Support personnel
Administrator
Size and Location Of Fire
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Small fire on the patient
Large fire on the patient
Fire in the patient
Airway fire
Equipment fire
Responsibilities - All Fires
• Alert team members to the presence of a fire
• Stop the flow of breathing gases to the patient
• Extinguish the fire by smothering or using water or
saline
• Push the back table away from the sterile field
• Remove burning material from the patient
• Assess for secondary fire
• Assess patient for injuries
Responsibilities - All Fires
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Notify appropriate personnel
Assign liaison to the families
Act as a liaison to the families
Complete an occurrence report
Gather involved materials and
supplies
ResponsibilitiesLarge Fire On the Patient
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Perform responsibilities for All Fires
Activate alarm system
Turn off oxygen shut-off valve outside of room
Extinguish any burning material off of the patient
Communicate with personnel in the surrounding
areas about the presence of fire
• Delegate responsibilities for non-direct care givers
• Assign a Traffic director
• Assist fire response team or fire department
personnel to location
Responsibilities
Large Fire on the Patient
• Assist with decision to evacuate
• Order evacuation of perioperative areas
• Communicate with personnel in surrounding
areas the need to evacuate
• Order the evacuation of unit
• Compile a list of all people in the perioperative
areas in case of evacuation
• Activate the disaster plan
Responsibilities
Airway or ET Tube Fire
• Perform responsibilities for All Fires
• Disconnect and remove the breathing circuit
• Discontinue the flow of breathing gases to the
patient
• Remove the ET tube and any segments of the
burned tube that remain in the airway
• Pour water or saline into the airway as directed
• Examine the airway
• Re-establish the airway
Responsibilities
Equipment Fire
• Disconnect the equipment from the electrical outlet
• Remove the working end of the equipment from
the sterile field
• Shut off the electricity to the equipment if you are
unable to remove plug from outlet
• Shut off gases to the equipment
• Assess the size of fire and determine if equipment
can be safely removed from room or to evacuate
• Extinguish fire using extinguisher, if appropriate
• Perform responsibilities for All Fires
Responsibilities
Fire Department
• Internal Fire brigade
– Responsibility
• External Fire Department:
– Should be notified of every perioperative fire
– Follow the facility policy and procedure
Contacting the
Fire Department
• Authority having Jurisdiction
– May assist with perioperative education
programs
– Determine types of fire extinguishers
– Determine location,storage, and
amounts of alcohol-based hand scrubs
Summary
Steps for surgical fire prevention
1. Know the components:
a) Ignition sources
b) Oxidizers
c) Fuels
2. Communicate:
a) Fire Risk Assessment
b) Presence of a Fire
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The end