Team Communication

Prevent Fire Risk in the O.R.: Team Communication

Fire in the O.R. is catastrophic. It usually happens when the team least expects it and the patient being high-risk has usually not been identified.  There is no clear data regarding how many fires occur in the O.R. although the ECRI institute estimates around 90-100 surgical fires occur each year. The anatomical locations where fires occur include the head, neck, or upper chest and elsewhere on the patient. Examples of fires on the patient include a fire on the drapes or the patient’s skin. It is also estimated that 21% of O.R. fires occur in the patient’s airway and 8% occur elsewhere in the body (e.g., within a body cavity). Unfortunately, many surgical fires result in disfiguring, disabling injuries and death for the patient.

Just like any other potential surgical patient injury, risk identification is key and needed to implement mitigating interventions.  Each surgical team should conduct a fire-risk assessment at the start of every surgery during the time out.  The assessment should be made to determine the presence of major risk factors such as: 

  1. Use of an open oxygen source
  2. The presence of an ignition source
  3. A procedure at or above the level of the xiphoid process
  4. Use of a flammable surgical prep solution


 If the patient is at an increased risk, decrease that risk through communication during the time out. Ensure that the team is aware and write it on a white board so that it is a visual reminder. Communicate with the anesthesiologist when an open oxygen source is being used in conjunction with an electric cautery pencil.  Remember to allow the surgical prep solution to dry using a timer, ensuring manufacturer’s recommendations are met.  Also, attempt to prevent pooling of skin prep solutions on or around the patient because some of these solutions, especially if they contain alcohol, will release fumes that are highly flammable. AORN recommends using a moist towel around the surgical site when using a laser and if doing throat surgery, using moist sponge packing in the throat to help protect the endotracheal tube. These are effective because water-soaked items, such as sponges or towels, require tremendously higher temperatures to ignite compared to what is required when they are dry. Use a water-based ointment and not an oil-based ointment on the facial hair and the hair close to the surgical site. The water-based ointment requires a very high temperature to ignite the hair beneath it.

While surgical fires are not very common, there needs to be a standardized plan in place to identify, communicate, and mitigate any risk associated with it. AORN has a great fire prevention assessment protocol, fire prevention assessment tool and work sheet that is available to help you standardize your fire safety process.