|Year : 2016 | Volume
| Issue : 2 | Page : 52-56
Prevention and control of operating room fires: Knowledge of staff employed by selected hospitals of Isfahan University of Medical Sciences
Habib Jalali1, Elahe Baloochestani Asl2, Asieh Maghami Mehr3, Seyed Mehdi Pourafzali4, Malihe Ghasemi5
1 Department of Operating Room, Ayatollah Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Operating Room Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Statistics, Payam Noor University, Shiraz, Iran
4 Department of Emergency Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
5 Department of Operating Room, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||30-Aug-2016|
Elahe Baloochestani Asl
Department of Operating Room Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjarib Ave, Isfahan
Source of Support: None, Conflict of Interest: None
Background and Objectives: Patient safety in hospital is an essential professional indicator that should be noticed. The thread of fires is of the most potentially dangerous risk that could harm patients and personnel. Hence, we studied operating room staff knowledge about fires, its prevention, and control, based on their specialty and their job tenure. Materials and Methods: This is a descriptive-analytical cross-sectional study. A cluster sampling method was applied, and a quota was considered for each hospital. In each cluster, samples were selected through census method. Data were collected using a three-part questionnaire and analyzed using SPSS version 17 (SPSS, Inc, Chicago, IL, USA). Results: The mean of their knowledge level about fires and its prevention was 2.71 (0.67), and control was 2.62 (0.71). In 66% of cases, the level of knowledge about fires and its prevention, and in 70% of cases, the level of knowledge about methods of fire control have been below the average (P < 0.05). As staff age increases, their level of knowledge increases as well. Hospital they are employed by, their job tenure, and their profession can affect the level of knowledge (P < 0.05). Discussion: This study shows that the staff knowledge about fires, its prevention, and control has been lower than the average limit. Due to the sensitivity of the issue, in terms of susceptibility of the environment and medical equipment for ignition, and also the safety of staff and patients, it is necessary to make facilities for development of staff knowledge, to eliminate defects of staff training by managers, and also to consider standards.
Keywords: Fire, knowledge, operating room staff
|How to cite this article:|
Jalali H, Asl EB, Mehr AM, Pourafzali SM, Ghasemi M. Prevention and control of operating room fires: Knowledge of staff employed by selected hospitals of Isfahan University of Medical Sciences. Digit Med 2016;2:52-6
|How to cite this URL:|
Jalali H, Asl EB, Mehr AM, Pourafzali SM, Ghasemi M. Prevention and control of operating room fires: Knowledge of staff employed by selected hospitals of Isfahan University of Medical Sciences. Digit Med [serial online] 2016 [cited 2020 Feb 26];2:52-6. Available from: http://www.digitmedicine.com/text.asp?2016/2/2/52/189506
| Introduction|| |
Operating room (OR) is considered as one of the most complex work environments in health-care services which is obvious in patients-related issues, treatment protocols, and using high-tech equipments  for a better adaptation with these improvements. Health-care systems requires an effective management to coordinate with these increasingly rapid changes to provide a better and safer service for both patients and staff.  The purpose of compliance with safety standards in the OR is to provide safety of all personnel working in this environment as well as safety of patients who are undergoing a surgical procedure.
Providing safety in the OR can be achieved by a team work where everybody in this system shares responsibility. Therefore, the periodic revisions of the safety requirements are certainly necessary.  OR safety can be studied from several aspects, including infection control, protecting against fires, safety of staff and patients related to the physical environment, etc.  Among all the cases subjected to the safety issues in the OR, fires are the most important potential hazards which should be noticed.  In addition, safety issues associated with fires are also an ethical and legal issue, since any damage caused by fires to the patients or personnel, requires not only legal actions but also costs a lot to pay for damages, blood money (restitution), costs of personnel disability due to injuries, and reproviding damaged equipment.  Hospital Administrators in the United States of America have estimated that about 100 fires occur annually in their hospital OR where averagely 10-20 cases lead to severe injuries and 1-2 cases result in death.  In Iran, we have no published official statistics or referral source to identify OR fires, but it does not reduce or deny the possibility of risk. Fire requires specific conditions and specific elements to start, including flammable materials, fire or heat, and oxygen. Normally, if these three elements are kept separated from each other, it would not be dangerous. However, in the OR, the probability of any event is unpredictable. If for any reason, two of the three elements get close together, it might be combustible. Materials including sponges, towels for dressing, drape towels, plastic materials such as pipes and syringe provide the raw material for the fire. Using light sources which radiate high amount of energy and heat such as lasers, light sources, fiber optic devices, electrical equipment such as a microscope, endoscope, monitors, and hyperthermia units in an environment rich in oxygen and anesthetic gases such as Nitrous oxide can be also effective in completing the cycle of fire.  Unfortunately, the issue of safety for fires in the OR is not still a matter of discussion at the top of priorities.  That might be due to misconceptions of the authorities about the low probability of an incident such as fires in a hospital OR.  To prevent fires during surgery, every OR staff should take special responsibility. It requires knowledge of all staff and a well-organized teamwork.  Related studies have shown that the most hospital staff, especially in an OR, have little knowledge about fire prevention and control. In a study by Davoodiantalab et al. about staff knowledge in Shiraz Hospitals, it was found that approximately 50% of staff had no enough knowledge about fire control.  Safavi et al. have also assessed knowledge of staff in Gillian University Hospitals. Results of their study indicated that the highest deviation from standards of safety in the OR has been in the preparation stage. These factors of safety include assessment of ventilation and temperature, checking oxygen bar, inlet and outlet valves of anesthesia machine, and so on.  Based on all these evidence, if the OR personnel have enough knowledge about sources of fire, its prevention, and methods of control, further injuries and damages can be avoided. Therefore, this study was designed to assess knowledge of OR staff about sources of fires, its prevention, and control in selected hospitals affiliated to Isfahan University of Medical Sciences.
| Materials and Methods|| |
This study is a descriptive, analytical design with a cross-sectional approach in which researchers evaluate the level of OR staff knowledge including OR technician, recovery nurse, anesthesia technician, nonspecialized personnel, surgeon, surgery resident, anesthesiologist, and anesthesiology resident, about fires, its prevention and methods of control in selected hospitals such as Ayatollah Kashani Hospital, Chamran Hospital, Alzahra Hospital, Feiz Hospital, and Imam Musa Kazim (AS) Hospital affiliated to the Isfahan University of Medical Sciences. A cluster sampling method was applied, and a quota was considered for each medical center. In each cluster, samples were selected through census method. Samples were included to the study if they were permanently employed in the OR, had at least 1 year of job tenure, and willingness to participate. All who were not eager to participate and failed to fill out the questionnaire and inexperienced ones such as undergraduate students and 1 st year residents were excluded from the study. Data were collected by means of a three-part questionnaire with 28 closed questions, in which the first section includes gathering demographic variables; the second section evaluates personnel's knowledge about fire resources and its prevention; and the third section measures their knowledge about methods of fire control. This researcher-made questionnaire was designed based on citing numerous studies in this area and also previously used questionnaires as well as the reviews of experts in this field to be localized based on our condition. Scoring criteria for each question were based on four alternatives that respectively were: I am completely aware of (4), I am quite aware of (3), I have little knowledge (2), and I do not know (1). The validity of the instruments was proved by using content validity and several stages of editing by experts and professionals. To approve the reliability of scale, Cronbach's alpha coefficient was used. It was calculated and confirmed 0.89 during a pilot study on ten subjects. Questionnaires were filled out by subjects after signing the informed consent. Data were analyzed using SPSS version 17 (SPSS, Inc, Chicago, IL, USA); descriptive statistics include mean, standard deviation, frequency distribution, and inferential statistics such as Chi-square, t-test, ANOVA, and Pearson correlation coefficient. All analysis was performed at the significance level of (0.05).
| Results|| |
In this study, there were 257 cases of OR personnel employed in selected hospitals affiliated to Isfahan University of Medical Sciences participated. A total of 162 (63%) were female, and 78 (30.4%) were male, and the mean of age was 35.06 (8.01) years. The highest employment rate in 94 cases (36.6%) was for OR technician, and the lowest employment rate in seven cases (2.7%) was for anesthesiologist. The mean of job tenure was 10.76 (7.74) [Table 1].
Assessing the level of knowledge about fires, preventive strategies, and control showed that the mean of level of knowledge about fires and its prevention was 2.71 (0.67), and also the mean of level of knowledge about methods of fire control was 2.62 (0.71). Binomial test results also showed that in 66% of cases, level of knowledge about sources of fires and its prevention, and in 70% of cases, the level of knowledge of the methods of fire control has been below the average (value = 2.5). The difference was considered statistically significant (P < 0.05). Hence, in general, it can be concluded that the level of knowledge about fires, preventive strategies, and control was lower than the average in Isfahan hospitals [Table 2].
|Table 2: Descriptive statistics of knowledge about fires, prevention, and control|
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The study of influencing factors on the level of knowledge revealed that gender differences did not affect the level of staff knowledge (P = 0.313). In contrast, as age increases, the level of knowledge about fires and prevention (correlation = 0.093) and methods of control (correlation = 0.139) has been increased. ANOVA test showed that this relationship has been statistically significant (P < 0.05). ANOVA also indicated that factors such as hospitals they are employed by, job tenure, and their profession can be effective in their level of knowledge (P < 0.05). In other words, anesthesiologists had the highest level of knowledge in contrast with nonspecialized personnel in the OR. Comparing the level of personnel knowledge among hospitals also showed that Imam Musa Kazim (AS) hospital staff had the highest level of knowledge in contrast with the Ayatollah Kashani hospital staff. In addition, by increasing job tenure, the level of knowledge increases as well [Table 3] and [Table 4].
|Table 3: Comparing level of staff knowledge about fire resources and prevention based on variables|
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|Table 4: Comparing level of staff knowledge about fire controlling methods based on variables|
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| Discussion|| |
Fires in the OR is one of the extremely dangerous events which can have catastrophic consequences. , Knowledge about fires, prevention, and control is essential for every hospital staff so that this event can be wisely managed.  As the results of this study show, staff knowledge about fires, prevention, and control is less than the average, which is consistent with other similar studies in our country. Mehdinia et al. designed a study to determine fires risk in Qom hospitals based on fire risk assessment engineering method to develop a program to enhance the safety of patients and staff. According to the results of their study, the risk of fires in all parts of hospital has been more than admissible level. In other words, the minimum acceptable safety for hospitals has not been provided. Accordingly, when the potential risk is high, knowledge deficit can worsen the situation. Hence, any occurrence of an accident such as fires may result in catastrophic and irreparable consequences such as people death, job interruption, high cost of repair and replacement of equipment, and also financial losses. Therefore, changes in system approach to improve safety are required.  In contrast with the previous study by Mehdinia et al., in a research of Mousavi et al. to determine the compliance with safety standards in hospitals affiliated to Tehran University of Medical Sciences, all the wards have been 84.9% safe which has been mostly for the physical environment. But still, the minimum safety has been for personnel who require refreshing and increasing knowledge. 
Regarding assessment of staff knowledge about fires, its prevention, and control, results of Bagheri et al. show that only 6.3% of staff had a good knowledge, 60.4% had an intermediate knowledge, and 33.3% had a poor knowledge. About 97.9% of hospital staff considered knowledge as a necessity. 
Davoodiantalab et al. found that regarding methods of fire prevention, 40.97% of the staff did not have knowledge, and 38.9% had poor knowledge. Regarding methods of fire control, 76% had no knowledge. They also found that staff knowledge is linked with their job tenure which is consistent with our results. But in contrast, they found that no significant relation is present between staff knowledge and their profession. As we indicated in our study, anesthesiologist had more knowledge than other OR staff. The overall results of their study show that staff knowledge about methods of fire control has been lower than their knowledge regarding fire prevention methods which is exactly consistent with our results. 
Shahbazi et al. in their study with similar objectives to us in Borujen hospitals found that 57.3% of staff had a fair knowledge, and 38.3% had poor knowledge about fires. All the participants have stated that so far they had no training courses about fire prevention and safety in OR. Based on their results, gender differences did not affect the level of staff knowledge which is consistent with the results of this study. In addition, the lowest level of knowledge has been for nonspecialized personnel. However, in contrast with our result, the highest knowledge level has been for surgeon.  Bruley found that fire prevention in the OR can be possible by raising staff knowledge about potential hazards and effective teamwork.  Association of Operating Room Nurses guideline has specified that based on previous studies, all fires in the OR is 100% preventable. Staff knowledge is of the most issue for this purpose.  Beyea has determined steps to prevent and control fires in the OR. It includes (1) staff knowledge about methods of fire control, (2) fire control process optimization, and (3) reporting the incidence of fires in OR. 
According to the results of our study, unfortunately, staff knowledge about fires, its prevention, and control methods has been below the average. Therefore, it is highly recommended that the authorities include training programs about fire and safety or related workshops in their educational planning for hospitals. All the staff should be aware of their responsibility toward their profession, patients, equipment, and environment.
The authors express thanks and appreciation to the authorities of Ayatollah Kashani Hospital, Alzahra Hospital, Chamran Hospital, Feiz Hospital, and Imam Musa Kazim (AS) for their cooperation in this study. Special thanks to the nursing executives, OR supervisors, and all the OR personnel who participated and answered questions honestly.
Financial support and sponsorship
The authors would also like to acknowledge "Deputy of Research at School of Nursing and Midwifery" for supporting this research project. The research code for the proposal of this research is 293067.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]