Burns in the Operating Room
The concept of a patient suffering a burn injury in an operating room may sound highly unlikely. Unfortunately, these types of injuries continue to occur every year in the United States and worldwide even with the most well-meaning professionals involved. Burns in the operating room can be physically devastating for the patient and very upsetting to the caregivers. Burn injury occurs from physical contact or close proximity with fire or heated items, electrosurgery unit malfunction, electrical shock or burn, or contact with chemicals. These injuries are known potential risks for patients undergoing procedures and they are most often preventable. Everyone in the OR or procedure room is responsible for the care and protection of the patient, and in that role all should be aware of the risk of patient burns and potential sources of a burn injury. Strict adherence should be maintained to training, policies, and protocols developed at your institution designed to prevent patient injury. Better awareness of the risks of burns should lead to an improved culture of safety surrounding these potential events.
There are a number of common causes of burns in the operating room including fire. We will present information that will allow you to be more aware of the risks and help create prevention strategies. Recommendations from several patient safety organizations will be discussed. In addition, we will review reaction and treatment steps that can be followed if an event does occur. The most dramatic of burn injuries, those due to fire and in particular airway fire, will be covered. Although burn injuries are rare, they can be devastating, and it is our hope that this chapter will help to increase awareness of burn injuries in the operating room and the steps that can be taken to protect our patients from this catastrophic perioperative complication.
KeywordsOperating room Anesthesia Patient safety Fire Fire triad Burns Electrosurgical unit Airway fire Laser Chemical burns
- 1.Burns. 2017. Retrieved 13 Nov 2017, from http://www.who.int/mediacentre/factsheets/fs365/en/.
- 2.ECRI Institute. New clinical guide to surgical fire prevention. Patients can catch fire—here’s how to keep them safer. Health Devices. 2009;328:314–332 6.Google Scholar
- 4.Center for Drug Evaluation and Research (U.S.). Preventing surgical fires – resources and tools for preventing surgical fires. 2015. Retrieved 13 Nov 2017, from https://www.fda.gov/Drugs/DrugSafety/SafeUseInitiative/PreventingSurgicalFires/ucm272680.htm.
- 5.Department of Health and Human Services. (2007 August, Ref: S&C-07-11, January 12, 2007), Use of alcohol-based skin preparations in anesthetizing locations. Centers for Medicare & Medicaid Services, Center for Medicaid and State Operations/Survey and Certification Group. 2007.Google Scholar
- 8.Apfelbaum JL, Caplan RA, Barker SJ, Connis RT, Cowles C. Practice advisory for the prevention and management of operating room fires. Anesthesiology. 2008;108(5):786–801. https://doi.org/10.1097/01.anes.0000299343.87119.a9.CrossRefGoogle Scholar
- 9.Roy S, Smith LP. What does it take to start an oropharyngeal fire? Oxygen requirements to start fires in the operating room. Int J Pediatr Otorhinolaryngol. 2011;227–30(13):75.Google Scholar
- 10.Barnes AM, Frantz RA. Do oxygen-enriched atmospheres exist beneath surgical drapes and contribute to fire hazard potential in the operating room? Am Assoc Nurse Anesth J. 2000;68(2):153–61.Google Scholar
- 11.Bovie Medical Corporation. Understanding electrosurgery [Brochure]. Clearwater: Author; 2016.. Retrieved 17 Nov 2017, from http://www.boviemedical.com/downloads/UnderstandingElectrosurgeryLit_r3.pdf.Google Scholar
- 12.Association of periOperative Registered Nurses. Fire safety tool kit [Brochure]. Denver, Colorado: Author; 2015.Google Scholar
- 14.Dennison DA. Scoring patients for fire risk adds to safety. Nursing. 2011;41(2):67–8. https://doi.org/10.1097/01.nurse.0000393113.03535.6b.CrossRefPubMedGoogle Scholar
- 15.Stoelting RK, Feldman JM, Cowles CE, Bruley ME. Surgical fire injuries continue to occur: prevention may require more cautious use of oxygen. APSF Newsletter. 2012;26(3):43.Google Scholar
- 18.Mehta SP. Burn injuries from warming devices in the operating room. Am Soc Anesthesiol Monit. 2013;77(2):16–7.Google Scholar
- 26.Warning! Severe burns and permanent scarring after glacial acetic acid mistakenly applied topically. NAN ALERT. 2013;1–2. Retrieved 17 Nov 2017, from https://www.ismp.org/NAN/files/20130121.pdf.