Colbey Reagan, a lawyer with Waller Lansden who has advised hospitals on legal fire-safety issues, says that in his experience, inadequate fire-safety drills are a common legal compliance problem for hospitals. “It can be difficult to run a fire-safety drill in a hospital,” he adds.
In addition to local fire codes, nearly all hospitals are legally governed by the requirements of the National Fire Protection Association's NFPA 101 Life Safety Code, which is updated every three years, most recently in September, Solomon says. The Joint Commission and the Medicare conditions of participation require hospitals to comply with NFPA 101.
Reagan says fire code issues can cause legal headaches for hospitals, especially if the local fire inspectors find that an IT employer has punched a hole in a firewall to run a new cable. He says it's a good idea to have someone in plant operations make regular inspections for such holes as part of a checklist.
In terms of legal compliance, Solomon says the most recent version of the code actually loosened some restrictions, including allowing more decorative elements inside hospitals and including more flexibility for moving wheeled equipment in hospital halls, including computers, diagnostic machines and patient lifts. Rather than banning moveable equipment from corridors, the code requires hospitals to train staff on moving it out of the way in an emergency.
However, not all fires threaten the safety of an entire building. Increasingly, many fires are confined to a patient's body or face.
Patient-safety experts say the rise in surgical flash fires coincides with the growth in popularity of outpatient procedures and the related use of oxygen during sedation. The flammable gas can ignite if it comes too close to surgical instruments such as electrocautery devices and lasers, especially if an alcohol pad was also used to clean the surgical site first.
Mark Bruley, vice president of accident and forensic investigation at the patient-safety organization ECRI Institute, says three surgical fires were reported at hospitals during one week in the beginning of December.
Surgical fires remain on the institute's top 10 list of hazards in hospitals (Nov. 7, p. 18). Of the 550 to 650 surgical fires estimated at hospitals each year, about 30 are considered “serious” and one or two result in patient deaths, Bruley says. But many, if not most of them, could be prevented.
“If we can get rid of the open delivery of oxygen on the patients' face, or at least question its need, that would likely get rid of well over half of the surgical fires that occur,” Bruley says. “What's needed is a cultural change, and in order to effect that, CEOs need to buy in to the need to prevent surgical fires and mandate surgical safety changes in their ORs.”