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January 1, 2018
Hazards posed by batteries and alcohol preps prompt a review of fire safety issues in clinics
Newly issued advisories about fire hazards in healthcare facilities by safety advocacy groups are placing new emphasis onto the importance of preventing fires in clinics.
Most surgeries take place in hospitals, but with outpatient procedures becoming more commonplace, alcohol preps are seeing wider use in medical clinics. However, a study published in the November 2016 issue of the Journal of the American College of Surgeons found that alcohol-based preps are alarmingly easy to ignite, even when dry.
While the preps caused only about 4% of OR fires, researchers found that fires occurred in 10% (six of 60) of electrosurgical test cases—even when they let the skin preps dry for three minutes and didn’t allow them to pool.
“Alcohol-based skin preparations fuel operating room fires in common clinical scenarios,” according to the study’s authors. “Surgeons can decrease the risk of an operating room fire by using non-alcohol-based skin preparations or avoiding pooling of the preparation solution.”
Alcohol-based skin preps used in the study included 70% isopropyl alcohol (IPA) with 2% chlorhexidine gluconate, 74% IPA with 0.7% iodine povacrylex, and plain 70% IPA. Researchers tested skin preps with and without alcohol, and applied them with and without pooling, according to the study.
Following manufacturer guidelines for drying time, the researchers used clipped, porcine skin and activated an electrosurgical pencil for two seconds on a 30-watt coagulation setting with room-air (21%) oxygen levels. When the same alcohol-based preps were allowed to pool, the frequency of fires rose from 10% to 27%. Additionally, when no drying time was allowed, alcohol-based preps ignited 22% of the time without pooling and 38% of the time with pooling.
Non-alcohol-based preps did not result in any fires, according to the study. According to some estimates, between 550 and 650 surgical fires occur every year, and it’s estimated that many fires are not reported, as they are considered “never events” that healthcare facilities strive to prevent.
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 ex-plode. 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 the wake of the report from the FDA, the Association for the Advancement of Medical Instrumentation has developed three priorities to help hospitals address this issue:
Conduct failure analyses for high-capacity batteries in the healthcare setting and develop a feedback loop with device and battery manufacturers so this information can be incorpo-rated into future designs
Develop new or update existing battery design standards to reflect the best practices found in UL’s Safety Issues for Lithium-Ion Batteries, AdvaMed’s Successful Practices for Battery-Powered Medical Devices, and other published documents
Train healthcare technology management professionals about safe battery management practices
The FDA says it has received medical device reports of hospital fires and other health hazards associated with the batteries used in mobile medical carts and their charges. These events—which include smoking, overheating, fires, and explosions—can occur with lithium, lead acid, and other types of batteries and result in equipment and facility damage, hospital evacuation, and patient and staff injury, according to the report. The report also warns that lithium battery fires are very difficult to extinguish. In several reports it received, firefighters had to bury mobile medical cart batteries to put out a fire.
The FDA recommends several steps for maintaining battery-powered carts or other battery-powered equipment in general, including the following:
- Inspect batteries for signs of damage, including bulging, swelling, or cracks.
- Notify the manufacturer of damaged batteries.
- Inspect battery chargers and carts containing chargers for overheating components.
- Vacuum to remove dust and lint around battery chargers and carts containing chargers.
- Do not use batteries that do not charge properly. Ensure that batteries are replaced at the manufacturer’s recommended intervals.
- Conduct a survey of battery charger locations, and verify that all chargers are located in easily visible, fire-retardant locations away from patient care areas and open sources of oxygen.
- Do not install chargers or charging carts in confined spaces.
- Keep flammable and explosive objects away from battery chargers and charging carts.
- Request preventive maintenance documentation from the cart manufacturer for the healthcare facility to use.
Most clinics and hospitals have done away with smoking and don’t allow it in patient treatment areas at all, out of precaution for both fire safety and general health. In many cases, smoking by employees on breaks is also prohibited. Of course, that doesn’t mean people don’t try to sneak smokes anyway—and sometimes this can end badly.
In 2013, a fire in an 11th-floor patient room at the University of Maryland Medical Center in Baltimore caused the death of its occupant, who was suspected of smoking. William Turner, 53, was killed in the fire, which caused $30,000 in damage. An investigation found that the fire apparently started in Turner’s bed.
A new trend, but apparently not a better one, is the advent of the e-cigarette. While they are popularly considered safer than regular cigarettes, there have been a small number of cases in which the devices have exploded because the batteries were overcharged or installed incorrectly. E-cigarettes are being blamed for a 2014 fire in a Syracuse, New York hospital that burned a patient on oxygen.
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 installa-tion 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 hospi-tal 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.