OR fire risk can increase with alcohol-based prep
OR fire risk can increase with alcohol-based prep
The use of alcohol-based surgical preparations in the operating room is gaining new attention as a potential fire risk, and one expert says risk managers should ensure that OR staff take specific steps to prevent serious injury.
Concern about the OR risk comes on the heels of a decision by CMS to allow hospitals to place alcohol-based hand rub containers in hallways, a decision that came only after CMS was assured that the alcohol would not be an unreasonable fire risk. Infection control professionals had pushed for more widespread use of the alcohol rubs, and the concern about the fire risk may have led to more focus on similar risks in the OR.
Now safety experts are reacting to a ruling by a regional CMS officer that prohibits the preparations containing alcohol when cautery, electrosurgery or laser devices are in use. The ruling came after a device sparked a surgical fire and burned a patient in Nebraska.
Alcohol has been a mainstay of antiseptic procedures, and infection control professionals expressed concern that its removal from operating rooms could lead to an increase in surgical site infections.
A National Fire Protection Association committee will meet in July to consider issuing clarification on the issue as a Tentative Interim Amendment (TIA) to the fire code. CMS is also working with the NFPA and the American Society for Healthcare Engineering (ASHE) of the American Hospital Association to allow the use of alcohol-based surgical preparation solutions if there is a timeout to allow the substance to dry.
In the meantime, risk managers should ensure that OR staff take a time out to allow the alcohol to dry before proceeding, advises Susan McLaughlin, MBA, CHSP, MT(ASCP)SC, president of SBM Consulting in Barrington, IL, and a codes and standards consultant to ASHE. She says the risk of fire from alcohol preps is real, but that forgoing them can raise the risk of infection. It’s a balancing act, she says.
"Of course, we have the risk of surgical site fires, and unfortunately there have been some," she says. "But we’re trying to reduce the number of hospital acquired infections. It truly becomes an education process that we have to undertake in the health care industry, to be able to use the materials that we need to use to provide the patient care, and use them safely."
The fire code doesn’t prohibit the use of alcohol-based products in the operating room, ASHE asserts in an advisory (www.ashe.org): "In fact, NFPA 99 (the fire code used by CMS) specifically addresses germicidal solutions in surgery and provides conditions for their safe use."
You can use the alcohol-based preparations safely with cautery or lasers if you follow a strict protocol, according to the Temporary Interim Amendment proposed by ASHE. Operating room personnel should make sure the solutions do not pool under the patient’s drapes, and should implement a timeout before starting a surgical procedure to make sure the solution has completely dried, ASHE advises.
Steps for avoiding alcohol fires in OR
McLaughlin says risk managers would be prudent to reinforce fire safety procedures in the OR and specifically address the safe use of alcohol-based preps. In addition to overall fire prevention strategies in the OR, make sure you enforce these three rules:
- Call a time out to check for drying before drapes are applied to the patient. "The key issue is that if these materials are used appropriately, and that means allowing them to dry before the drapes are applied, they should be effective in reducing the infection risk without contributing to fire during surgery," McLaughlin says. "OR staff must understand that if the drapes are applied too soon, before the alcohol has dried, the alcohol can pool under the drapes and then ignite from any number of sources during surgery."
- Use unit-dose applicators whenever possible. That ensures that nurses and techs use enough for reducing infections without using too much and increasing the fire risk, McLaughlin says.
- Any material that becomes soaked in the alcohol prep must be removed from the surgery area entirely.
The Nebraska case dramatically highlights the fire hazard in an operating room. An 86-year-old woman was undergoing a biopsy when the linens supporting her head caught fire. She received severe burns to her head, neck, and shoulders and died of pneumonia a month later, according to news reports.
Meanwhile, CMS officially has allowed the placement of containers of alcohol-based hand rubs in hospital hallways. As of May 24, CMS is adopting the amendment to the NFPA Life Safety Code that allows the dispensers.
The amendment dictates the size, spacing and placement of the containers. For more information, see www.ashe.org/ashe/codes/handrub/ index.html.
Claims and costs way up for long-term care providers
If your organization provides any long-term care services, you’ve probably seen your liability costs go through the roof recently. You’re not alone, according to data from Aon, a Chicago-based provider of risk management services and insurance.
Aon recently released information showing that, across the United States, the frequency of claims filed annually has more than doubled and severity has tripled in the long-term care sector since 1996. The Long-Term Care 2005 General Liability and Professional Liability Benchmark Analysis found that general liability and professional liability (GL/PL) costs for the long-term care profession have increased 182% since 1996. It also recorded that the annual patient care liability cost for each occupied bed in a long-term care facility has grown from $430 in 1993 to $2,310 in 2004, explains Theresa Bourdon, FCAS, MAAA, managing director and actuary at Aon.
"Following trends initially observed in Florida and Texas, an alarming number of states are experiencing dramatic increases for GL/PL coverage," Bourdon says. "In fact, 14 of the 16 states analyzed experienced double-digit annual increases in their GL/PL costs over the past decade, with a majority of them experiencing loss cost trends in excess of 25%."
The most notable states experiencing escalating loss costs are Arkansas, Mississippi, California, Georgia, Alabama, Arizona, and Tennessee.
"This is not good news for providers," Bourdon says.
No one safe from liability costs now
The rising costs of long-term care liability now are hitting everyone, she warns.
"Even if you’re not operating in what were notoriously the worst states for liability against long-term care providers — Florida and Texas for instance, — you should still be concerned," Bourdon says. "This issue is spreading across the country."
A casual reading of the Aon report could suggest the costs are leveling off, but Bourdon warns that many factors are driving a continuing increase in costs. Some states have seen a leveling off because some deep pocket insurers left Florida and other states with a lot of retirees, and tort reform has helped in other states, including Texas.
One significant improvement in Texas was the provision of the state’s tort reform that limits "stacking," in which multiple relatives of an injured or deceased family member would file separate claims. Caps on the total payouts also had a large impact, Bourdon says.
The study, which represents 23% of the total number of long-term care beds in the United States, reveals that tort reform passed in Texas in 2003, and strengthened by a constitutional amendment, appears to be having the greatest impact among the states analyzed on reducing GL/PL claim costs. GL/PL loss costs in Texas peaked at $6,720 in 2002 but have dropped substantially to $3,390 in 2004.
The study also found that the number of claims per year that long-term care operators incur has more than doubled, from 6.2 per 1,000 occupied skilled nursing care beds in 1996 to 13.1 in 2004, and the average cost per claim has increased to close to $180,000. As well, the study found that annual commercial insurance premium levels have increased for the fourth straight year.
Time to revisit your prevention strategies
Bourdon says risk managers should see the cost data as reason to revamp their prevention efforts in long-term care, making it a special focus for all clinical and general risk management efforts.
"Address all you can internally and also be active in policy debates on tort reform," she says. "This is a cost of doing business and it is showing no signs of decreasing. It needs to be recognized across the country, not just in what had historically been a few states that were especially hard hit by these costs."
Bourdon recommends that nursing and long-term care providers should join forces with the physician community to be front and center in the fight for tort reform.
"Physicians have made some headway in recent years. Long-term care providers should learn from that success and push for more protection," she says.
Funds diverted from other needs
Hal Daub, president and CEO of the American Health Care Association and the National Center for Assisted Living, both in Washington, DC, says the increased liability costs are hurting more than just health care providers.
"The long-term care liability crisis is forcing scarce Medicaid taxpayer dollars intended to fund quality long-term care services for our nation’s frail, elderly, and disabled to be diverted to pay for unnecessary defense costs and inordinately expensive settlements," he says. "This Aon study illustrates that trial attorney fees and other litigation expenses make up nearly half of the total amount of costs paid for liability claims in long term care. These are funds that ought to be directed to patient care."
The analysis is based on data from 76 long-term care providers operating around the country. The participants combined currently operate approximately 445,000 long-term care beds, consisting primarily of skilled nursing facility beds, but also including a number of independent living, assisted living, home health care and rehabilitation beds.
To access the complete study and gather more detailed information on individual states, go to www.aon.com or www.ahca.org.
The use of alcohol-based surgical preparations in the operating room is gaining new attention as a potential fire risk, and one expert says risk managers should ensure that OR staff take specific steps to prevent serious injury.Subscribe Now for Access
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