Effective surgical fire prevention begins with an ongoing, comprehensive risk assessment. Unlike other areas of a health care facility, operating rooms require heightened attention because fires can occur in or on the patient. | Photo Credit (all): Courtesy of Accreditation Commission for Health Care Inc.
By Richard Parker, MBA, CHFM, CLSS-HC, FASHE, FACHE
Operating rooms combine oxygen-enriched environments, flammable preparations, combustible materials and ignition sources — often in close proximity to the patient. As technology, surgical tools and clinical practices evolve, health care organizations must move beyond basic compliance and adopt proactive, practical strategies to reduce fire risk.
While surgical fires are infrequent, the impact is real: an analysis of FDA adverse event data identified 565 surgical fire events over a 20-year period that resulted in harm to patients or surgical personnel, underscoring why proactive prevention matters.
“Operating rooms are dynamic environments that need to be regularly evaluated for patient and staff safety,” says Richard Parker, associate director, physical environment and life safety at Accreditation Commission for Health Care (ACHC). “Risk changes based on the procedure, equipment and even the people in the room. What may be safe in one procedure can become a hazard in another.”
Safety experts with the ACHC recommend facilities implement the following four best practices to strengthen their surgical fire prevention protocols and ensure patient and staff safety.
1. Start With a Risk Assessment That Reflects Reality
Effective prevention begins with an ongoing, comprehensive risk assessment. Unlike other areas of a health care facility, operating rooms require heightened attention because fires can occur in or on the patient.
Risk assessments should evaluate electrical equipment, energy devices such as electrosurgery units and lasers, oxygen delivery methods and the presence of flammable materials. Additionally, facilities should conduct regular check-ins to reflect new technologies, updated procedures and staffing changes.
“Too often, risk assessments become check-the-box exercises,” says José Domingos, president and CEO of ACHC. “The most effective organizations take the time to review conditions as they change and adjust their controls accordingly.”
Assessment also ensures that hospitals have appropriate fire extinguishers readily available. While dry chemical extinguishers are common throughout health care facilities, their use on or near a patient can introduce additional hazards. Many facilities place water mist or carbon dioxide extinguishers inside procedure rooms, with dry chemical units positioned just outside to minimize patient risk.
2. Control Flammable Agents and Combustible Materials
Flammable skin preparations, germicides and antiseptics remain leading contributors to surgical fires. Alcohol-based solutions, including aerosolized hand sanitizers, require careful handling and clearly defined procedures.
Best practices include preventing pooling of flammable liquids, allowing adequate drying time before draping and removing solution-soaked materials before using energy devices such as cautery or lasers. Facilities should also evaluate how flammable agents interact with other combustibles, including drapes, gowns and surgical tools. Incorporating these considerations into pre-procedure “time-out” processes ensures risks are addressed before surgery begins.
“Surgical fire prevention depends on well-executed coordination,” Parker says. “When teams understand how these elements interact, they’re better equipped to prevent an incident before it happens.”
3. Develop OR-Specific Emergency Procedures
Fire response plans designed for general building fires do not always translate effectively to operating rooms. Surgical fire procedures must account for patient safety, equipment shutdown and immediate control of hazards unique to the surgical environment.
Emergency procedures should address alarm activation, equipment shutdown and management of secondary emergencies such as chemical spills or burning drapes. Additionally, it’s vital that staff understand their assigned roles and know how to respond if a fire involves a patient.
Extinguisher training is another critical element. Staff should know which extinguisher types are appropriate for different classes of fires and understand how their use may affect patient safety. This knowledge can make the difference between a controlled response and a rapidly escalating emergency.
4. Reinforce Preparedness ThroughRegularTraining and Drills
Even the most detailed fire response plan is ineffective without regular training. Orientation programs should include general safety instruction and operating room-specific fire prevention education. Ongoing training reinforces expectations and keeps safety top of mind.
Annual operating room fire drills, conducted separately from general facility drills, allow teams to practice assigned roles and identify gaps in procedures or communication. Drills do not involve patients but should simulate realistic emergency conditions, ensuring staff can respond confidently under pressure.
“Training and drills serve as a critical validation of both individual competency and organizational readiness,” Domingos says. “They help ensure that accredited education translates into consistent, real-world performance, supporting patient safety by confirming that teams, equipment and procedures align as intended when seconds matter.”
Facilities should review any fire-related incidents or near misses and update procedures as needed. Fire prevention plans should be reviewed annually or whenever equipment, staffing or processes change, keeping the organization proactive rather than reactive.
5. Proactive Safety in a High-Risk Environment
Surgical fires are high-risk, low-frequency events with potentially severe consequences. By focusing on realistic risk assessments, controlling flammable agents, developing operating room-specific emergency procedures and reinforcing preparedness through training, health care organizations can significantly reduce that risk.
Ultimately, surgical fire prevention is more than compliance. It requires understanding modern operating room risks and taking proactive steps to protect patients and staff.
In today’s healthcare landscape, proactive risk management is essential to patient safety and organizational reputation. Accreditation organizations, like ACHC, provide health leaders with evidence-based surgical fire prevention strategies that reduce liability, ensure compliance and demonstrate your facility’s unwavering commitment to safety.
Richard L. Parker is associate director, physical environment and life safety at Accreditation Commission for Health Care Inc. where he provides guidance to customers and surveyors in the ASC and hospital programs. Prior to joining ACHC full-time, Parker was an accreditation surveyor and Executive Director of Facilities for a 615-bed hospital system in Arizona.