On August 8, 2005 the National
Fire Protection Association (NFPA) notified ASHE (American Society
of Hospital Engineers) of its acceptance of ASHE's Tentative
Interim Amendment (TIA) to NFPA 99 – Standard for Health-Care
Facilities – 2005 edition at the July Standards Council
meeting. The amended language (see below) was published in the
August 2005 edition of NFPA News.
ASHE proposed this amendment to NFPA 99 to provide
additional guidance to help health-care facilities effectively manage
fire risk when alcohol-based surgical prep solutions are used in
the presence of an ignition
source (laser,
ESU,
cautery,
etc.). This proposal was in response to enforcement of existing
NFPA 99 language that prohibited alcohol skin prep in the presence
of an ignition source. ASHE shared its concern about the potential
for intraoperative fires when alcohol-based surgical-prep solutions
are used near a flammable source. However, we felt the potential
risk should be considered in light of the potential risk of banning
or restricting use of these products in operating rooms. Appropriate
skin antisepsis before surgery remains a critical measure for prevention
of surgical-site infections. On March 18, ASHE provided a regulatory
advisory to ASHE members with recommendations for the safe usage
of alcohol surgical-prep solutions, to minimize the potential for
fire while continuing to allow the use of these critical infection-control
products. That alert emphasized the need to use prep solutions
according to manufacturer instructions and introduced a “time-out”
before initiating activation of the ignition source. The time-out
would ensure there was no pooling of fluid or soaking of drapes,
and that the solution had fully dried. That alert was the basis
of the TIA.
Amendment to NFPA 99 – 2005 edition includes:
13.4.1.2.2.2* Flammable liquid germicides
or antiseptics used in anesthetizing locations, whenever the use
of electrosurgery,
cautery or electrosurgery a laser is contemplated shall be nonflammable
packaged to ensure controlled delivery to the patient in unit-dose
applicators, swabs, and other similar applicators.
13.4.1.2.2.3 Whenever the application of flammable
liquid germicides or antiseptics is employed in surgeries where
the use of electrosurgery, cautery or a laser is contemplated time
shall be allowed to elapse between application of the germicide
or antiseptic and:
(a) The application of drapes to permit complete evaporation and
dissipation of any flammable vehicle remaining, and
(b) The use of electrosurgery, cautery or a laser to ensure the
solution is completely dry and to permit thorough evaporation and dissipation
of any flammable vehicle remaining
13.4.1.2.2.4 Any solution-soaked materials
shall be removed from the operating room prior to draping
and use of electrosurgery, cautery or laser.
13.4.1.2.2.5 Pooling of flammable liquid germicides
or antiseptics shall be avoided. If pooling occurs, excess solution
shall be wicked and the germicide or antiseptic allowed to dry
completely.
13.4.1.2.2.6 A preoperative time-out
period shall be conducted prior to the initiation of
any surgical procedure using flammable liquid germicides
or antiseptics to verify that a flammable germicide or antiseptic:
(a) Application site is dry prior to draping, and use of electrosurgery,
cautery or a laser, and
(b) That pooling of solution has not occurred, or has been corrected,
and
(c) Any solution-soaked materials have been removed from the operating
room prior to draping and use of electrosurgery, cautery or a laser
13.4.1.2.2.7 Whenever flammable aerosols
or antiseptics are employed, sufficient time shall be
allowed to elapse between deposition and application
of drapes to permit complete evaporation and dissipation
of any flammable vehicle remaining.
13.4.1.2.2.8 Health-care organizations
shall establish policies and procedures outlining safety
precautions related to the use of flammable liquid or
aerosol germicides or antiseptics used in anesthetizing
locations, as required in Section 13.4.1.2.10, whenever
the use of electrosurgery, cautery or a laser is contemplated.
A.13.4.1.2.2.2 Some tinctures and solutions of disinfecting
agents provide significant clinical benefits in reducing the risk
of surgical infections. However, they can be flammable, and can be
used improperly during surgical procedures. Tipping containers, accidental
spillage and the pouring of excessive amounts of such flammable agents
on patients expose them to injury in the event of accidental ignition
of the flammable solvent. To control this risk, flammable germicides
or antiseptics used when electrosurgery, cautery or a laser is contemplated
should be packaged to ensure controlled delivery to the patient (e.g.,
unit-dose applicator, swab, etc.) in small volumes appropriate for
single application.
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