Special Considerations in the Perioperative Environment for Registered Nurses

Fire in the OR

Perioperative fires were common in early operating rooms until the use of flammable anesthetics were discontinued in the 1970’s. Despite this change, the perioperative environment comprises all three components required for a fire, and fires do occur.

(Murphy, 2019)

Ignition Source: The ignition source provides the energy required to start a fire.

Fuel Source: The fuel source is anything that can burn.

Oxidizer Source: The source of oxygen helps to feed a fire.

In the OR, sources of energy include:

Static Electricity
Ignition Source

Electrosurgical units (i.e., Cautery machines)
Ignition Source

Lasers
Ignition Source

Fiber-Optic Light Cords
Ignition Source

Drapes
Fuel Source

Sponges
Fuel Source

Towels
Fuel Source

Patient’s Hair
Fuel Source

Flammable Prep Solutions
Fuel Source

Anaesthetic gases such as oxygen, nitrous oxide, or even room air
Oxidizer Source

Fire Prevention and Management in Three Steps

The three steps of fire prevention and management in the OR include:

  1. Prevent
  2. Extinguish
  3. Evacuate
Prevention of Fire

The first step is PREVENTION. It is important for perioperative nurses to understand the fire triangle because eliminating any of the three components can prevent a fire. In earlier modules, you learned about some fire prevention methods such as:

  1. Allowing prep solutions to dry completely before draping. (Prepping and draping module)
  2. Taking fire prevention steps when using lasers and electrosurgical units. For example, placing moist towels around the tissue where the laser will be operating. (Equipment module)
  3. Turning on the light source in laparoscopic surgery only when ready to use, and not leaving an active light lying on a drape. (Advances in technology module)
Prevention of Fire During Head and Neck Surgery

Surgery involving the head and neck always increases the risk of fire as the surgical team is working near an oxidizer source. During these procedures, the perioperative team takes additional precautions including:

  1. Using medical grade air rather than oxygen if the patient can tolerate it and maintaining O2 saturations. If not, then using the lowest concentration of O2 possible and securing the airway with a laryngeal mask or endotracheal tube.
  2. Communicating with the anesthesia provider and, when possible, stopping supplemental O2 delivery at least one minute before using laser or electrocautery near the airway.
  3. Towelling drapes as far away from the incision site as possible.
  4. Placing drapes in a manner that does not allow for buildup of O2 gases.
  5. Using bipolar rather than monopolar cautery when possible.
  6. Coating any hair exposed on the surgical field in a water-soluble jelly that is non-flammable.
  7. Using moistened sponges when possible.

(Murphy, 2019; ORNAC, 2021)

Extinguish: Emergency Management of Fires in the OR

The Second Step

The second step of fire prevention and management is EXTINGUISH. If a fire is detected in the OR, the perioperative team must follow these steps.

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Once the fire has been extinguished, the perioperative team must consult to determine if the procedure can be completed and what the next steps for management are.

(Murphy 2019)

Evacuate

All perioperative personnel should receive annual fire safety training which includes a plan for evacuation in the case of a fire in the operating room or in the hospital/institution. Evacuating during a surgical procedure is a last resort, but all staff must be aware of the steps to take in case an evacuation is required.

Onsite Fire Training

It is vital that all perioperative team members are trained and have knowledge of the organization’s protocols and steps to take in the event of a fire. ORNAC standards note that all perioperative nurses must know:

  1. What their individual responsibilities are in the event of a fire.
  2. Where the fire alarms are in rooms and within the perioperative environment.
  3. The location of the fire exits as well as the evacuation routes and techniques.
  4. How to report a fire.
  5. Locations of shut off valves for all gases including O2.
  6. Equipment location and how to use it for fighting fires.

(ORNAC, 2021)

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