Preventing Fires in the OR

The full article appears in the January 2018 issue of Patient Safety Monitor Journal.

An unplanned fire is the ultimate sign that things have gone sideways.
Despite being labeled a never event and countless regulations on how to prevent them, fires still break out in hospitals. Between 2012 and 2014 there were 5,700 medical facility fires reported to fire departments. And the ECRI Institute estimates there’s an annual 500–600 fires that occur in, on, or around a patient undergoing a medical or surgical procedure.
While fires are a rare occurrence in hospitals, when they do happen they can cause an inordinate amount of harm. Now, newly issued advisories about fire hazards in healthcare facilities by safety advocacy groups are placing new emphasis onto the importance of preventing fires.
Hand sanitizer
The fire danger of hand sanitizer catches many people off guard. The high alcohol content in hand sanitizer makes it a great disinfectant, but also a major fire hazard, which is why there are strict fire codes that require a collection cup under dispensers and prevent their installation above electrical outlets.
Fires from hand sanitizer are rare, but they do happen. To illustrate the danger, one only needs to look at the case of James Ditucci, an 8-year-old boy from Boston who was taken to a hospital with major burns after he decided to copy a hand sanitizer stunt he saw on YouTube.

According to a Forbes report, the boy’s mother awoke to screams and second-degree burns on 15% of the boy’s body after a sleepover with his cousin and 10-year-old brother. Sanitizer got on Ditucci’s hands and shirt, exacerbating the extent of the burns.
The children were apparently trying to mimic a flaming hand sanitizer video that claims there is a safe method to avoid burning your hands, suggesting it may be done safely if you only handle the flaming gel for a few tenths of a second. The high ethyl alcohol content in the product—up to 62% in some cases—makes hand sanitizer highly flammable and apt to lead to burns.
A fire in February 2013 at Doernbecher Children’s Hospital in Portland, Oregon, left a 12-year-old girl with third-degree burns over a fifth of her body. The girl, who was in the hospital for kidney cancer treatment, reportedly used hand sanitizer to clean a table and olive oil to remove glue residue from leads stuck to her head. She rubbed the plastic mattress she was lying on, and the vapors from the sanitizer caught fire and were fed by the oil in her hair and on her shirt.
Battery hazards
The FDA last year issued a warning to healthcare professionals and administrators of the potential safety risks associated with battery-powered mobile medical carts following reports of explosions, fires, smoking, or overheating of equipment. Such incidents have required hospital evacuations, according to the FDA. This warning comes as carts are becoming more widely adopted in clinics, together with the more common use of laptops and other battery-powered equipment.
“When a lithium ion battery fails, it has the potential of exploding. We had a laptop explode. Fortunately, it was not being carried when it happened,” says Bruce Cunha, RN, MS, COHNS, a former manager of employee health safety at the Marshfield (Wisconsin) Clinic. “Make employees aware that if a battery device starts smoking, [they should] get away from it immediately.”
Battery-powered medical carts include crash carts, medication dispensing carts, and carts that power medical devices, barcode scanners, and patient monitors, according to the FDA report. They usually have high-capacity lithium or lead acid batteries that are capable of powering devices and computers for hours. In some cases, firefighters have had to bury medical carts to put out the flames.

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