1. Background Fire occurs when the elements that support combustion (ignition source, a fuel source and an oxidiser) come together. These three elements are referred to as the fire triangle and all are present in abundance within the perioperative environment. Keeping the sides of the fire triangle apart is critical to fire prevention and ensuring patient safety. Ignition sources are the electrosurgical unit and the fibre-optic light. Most items in the perioperative environment are considered to be a fuel source (alcohol, plastic s etc.). Oxidisers include oxygen and nitrous oxide. 2. Purpose So all Nursing and Anaesthetic Technician staff are aware of fire safety in the Operating Theatre. 3. Application This procedure is to be followed by all WCDHB clinical members including contracted locum staff. 4. Definitions All clinical staff are required to Ensure they abide by the requirements of this protocol. 5. Resources Required No resources required. 6. s 1.00 Surgical team members will - survey the inflammable materials that may be on or around the patient including liquids (e.g. alcohol-based skin antiseptic) petroleum or oil based lubricants or ointments gases (e.g. oxygen, methane, anaesthetic agents, alcohol vapour plastics paper or gauze surgical drapes foam positioning devices Fire Safety in the Operating Theatre Page 1 of 6
adhesive or plastic tapes endotracheal tubes. 1.1 Be able to recognise early signs of a fire (i.e. unusual sounds such as popping, snap or foomp, unusual odours, unexpected smoke and/or heat, unexpected patient movement or movement of drapes, unexpected flash or flames). 1.2 Know how to initiate a fire alarm. 1.3 Know how to use a fire extinguisher. 1.4 Know the stages of fire evacuation. 1.5 Understand this operating theatre s fire evacuation plan. 1.6 Have received mandatory training on fire education. 1.7 If a fire does occur, save all involved material and devices for inspection following the event. 1.8 Ensure an incident form is generated. 2.0 The Instrument Nurse shall - 2.1 Ensure sufficient drying time is allowed for flammable skin preparation solutions and that the solution does not pool under the patient. 2.2 Ensure surgical drapes are configured to minimise the accumulation of oxidisers. 2.3 Ensure that the fibre-optic light lead is turned off when not in use. 2.4 Provide moistened sponges and gauzes to be used when in proximity to ignition sources. 2.5 If a fire occurs, remove from the patient any materials that may be on fire and help extinguish the fire. 2.6 Once fire is extinguished, cool burnt tissue to minimise damage. 2.7 Assist with patient care i.e. transport (gather supplies and cover wound). 3.0 The Circulating Nurse shall - 3.1 Check patient on admission to theatre for flammable items e.g. hair spray, and alert the surgical team. 3.2 Remove material or articles soaked with flammable skin prepping solution. 3.3 Observe the integrity of all electric cables prior to use; do not use and report if any damage is detected. 3.4 Activate fire alarm system to notify relevant personal if a fire occurs. 3.5 Attempt to extinguish any small fire. 3.6 Ensure instrument nurse has supplies he/she requires. Fire Safety in the Operating Theatre Page 2 of 6
3.7 Prepare patient for transfer, if patient is burnt. 3.8 Collect relevant documentation as is safe to do. 3.9 Be aware of the safest route if evacuating. 4.0 The Anaesthetic Technician shall - 4.1 Ensure active gas scavenging to minimise gas build up. 4.2 If fire occurs, assist the anaesthetist as required e.g. collect ambu bag for use. 4.3 Collaborate with the Circulating Nurse. 4.4 If the patient is aware of the fire, remain with them providing comfort and safety. 4.5 Prepare patient for transfer / evacuation if required. 4.6 Collect the necessary medications to continue anaesthesia during transport. 5.0 Prevention of fire on or in equipment 5.1 Inspect electrical cords and plugs for integrity and remove from service if they are broken. 5.2 Check biomedical inspection stickers on equipment for currency and remove if not current. 5.3 Keep fluids off electrical equipment (ESU unit). 5.4 Do not bypass or disable equipment safety features. 5.5 Use medical equipment/devices according to manufacturer s instructions for use. 6.0 Handling a fire on a patient. - Small flames or small area. 6.1 Alert team members to the presence of a fire. 6.2 Pour water or normal saline on the fire slowly to prevent spreading and to extinguish the fire, if it can be accomplished safely. 6.3 Lay a wet towel or sponge over the flame, place one arm over the end of the towel nearest the patients head, and sweep the other arm over the towel and towards the patient s feet. 6.4 Lift the material used to smother the flame to vent heat. 6.5 Remove burning material from the patient. 6.6 Assess the surgical field for secondary fire on underlying drapes or towels. 6.7 Access the patient for injuries and report to physician. 6.8 Document the fire, notify relevant hospital personal. Fire Safety in the Operating Theatre Page 3 of 6
7.0 - Large flames or large area 7.1 Alert all team members of the fire 7.2 Communicate with the anaesthetic team, who will stop the flow of gases to the patient, and disconnect the breathing circuit form the anaesthetic machine. 7.3 If a drape is the cause, remove it to the ground if possible and roll it on itself to smother the fire, avoiding the evacuation route for people in the room. 7.4 Assess the surgical field for a secondary fire. 7.5 Assess the patient s injuries and report to physician. 7.6 Verify the flames are extinguished and use a fire extinguisher if necessary. 8.0 Handling a fire in a patient 8.1 Alert team members to the presence of the fire. 8.2 Consult with the anaesthetic team if the fire is an airway fire, assist the team as necessary. disconnect and remove anaesthetic circuit turn of oxygen flow remove endotracheal tube (may not be whole) pour saline/water into the airway if instructed re-establish airway. 8.3 Assess the surgical field for secondary fire. 8.4 Access the patient for injury and report injuries to physician. 8.5 Activate alarms if necessary. 8.6 Document occurrence. 9.0 Handling a fire on a piece of equipment 9.1 Alert the team members to the presence of fire. 9.2 Disconnect equipment from the electrical source. 9.3 Shut off the electricity to the piece of equipment at the electrical panel if not possible to remove the plug from the outlet. 9.4 Shut of gases to the equipment, if applicable. 9.5 Assess the size of the fire and determine whether equipment can be removed from the room safely or the room needs to be evacuated. 9.6 Use fir extinguisher if appropriate. 9.7 Activate alarms if necessary. 10.0 Electrosurgical Unit (ESU) Care of to avoid the potential risk of fire Fire Safety in the Operating Theatre Page 4 of 6
10.1 Place ESU in a location that does not put stress on the electrical cord. 10.2 Keep the electrical cord dry, free of kinks, knots and bends. 10.3 Inspect the ESU cords prior to use and do not use if there is evidence of breaks, nicks or cracks in the outer insulations coating. 10.4 Keep the active electrode cord free of kinks and coils during use. 10.5 Only one person controlling the active electrode activates the ESU. 10.6 Use the lowest possible power setting, and use cut or blend settings instead of coagulation when possible. 10.7 Do not store any form of solution or damp swabs etc. on ESU unit. 10.8 Keep surgical drapes away from active ESU. 10.9 Keep the active electrode tip clean. 10.10 Do not activate the active electrode in the presence of flammable agents until the agents are dry and the vapours have dissipated. 10.11 Use only active electrodes or return electrodes that are compatible with the ESU. 10.12 Do not alter the active electrode tip. 10.13 Ensure the electrode tip and hand piece are placed in their isolating sheath when not in use. 10:14 Inspect all insulated instruments used for electrosurgery for impaired insulation and remove from service if not intact. 10:15 Ensure the electrode earthing plate is well attached to the patient. If the patient has excessive body hair the area will need to be shaved (and recorded in their notes). Also ensure no alcohol prepping has pooled around the earthing plate. 10:16 The electrode earthing plate must be placed as far away as possible from any metal or prosthesis. 11.0 Fibre Optic Light Use 11.1 Place light source in standby mode or turn off when cable not in use. 11.2 Inspect light cable prior to use and remove if not intact. 11.3 Connect all fibre-optic light cables before activating the light source. 11.4 Secure the working end (i.e. the end that is inserted into the body) of the telescope on a moist towel or away from drapes, sponges or other flammable materials. For Assessment and Management of Burns please refer to the WCDHB Assessment and Management of Burns on the WCDHB intranet (Policies and s). Fire Safety in the Operating Theatre Page 5 of 6
7. Related Documents WCDHB Evacuation Policy WCDHB Assessment and Management of Burns 8. References ACORN Standards for Perioperative Nursing 2012-2013 AORN Perioperative Standards and Recommended Practices 2013 REVISION HISTORY Version 2 Developed By CNM Operating Theatre Authorised By CNM Operating Theatre Date Authorised October 2014 Date Last Reviewed February 2015 Date of Next Review February 2017 Fire Safety in the Operating Theatre Page 6 of 6