Prevention and Control of Operating Room Fires: Knowledge of staff employed by selected Hospitals of Isfahan University of Medical Sciences
Mr. Habib Jalali, Ms. Elahe Baloochestani Asl, Ms. Asieh Maghami Mehr,
Dr. Seyed Mehdi Pourafzali, Ms. Malihe Ghasemi
Isfahan University of Medical Sciences, Isfahan, Iran
*Corresponding Author Email: khjalali94@gmail.com, e_baloochestani@nm.mui.ac.ir, asimaghami@yahoo.com, m_purafzali@yahoo.com, ghasemi1359@gmail.com
ABSTRACT:
Background: 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. So, we studied operating room staff knowledge about fires, its prevention and control, based on their specialty and their job tenure.
Methods: This is a descriptive analytical cross sectional study which evaluates knowledge of operating room staff in relation to fires. 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, descriptive statistics, and inferential statistics.
Results: 257 cases of operating room staff employed by selected Hospitals (IUMS) Participated. 63% were female and 30/4% were male. The most employment rate was (36/6%) for OR technician and the less was (2/7%) for anesthesiologist. 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, has been below the average (the value=3). This difference was statistically significant (P<0/05). As staff age increases, their level of knowledge increase as well. Hospital they are employed by, their job tenure, and their profession can affect 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 equipments for ignition, and also safety of staff and patients, Therefore making facilities for development of staff knowledge, managers strive to eliminate defects of staff training, and also considering standards seems to be necessary.
KEYWORDS: Fire, Operating room staff, Knowledge.
INTRODUCTION:
Background:
Operating room 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.1 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.2
The purpose of compliance with safety standards in the operating room 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 (operating room) 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.3 Operating room safety can be studied from several aspects, including infection control, Protecting against fires, Safety of staff and patients related to the physical environment, and etc.4 among all the cases subjected to the safety issues in the operating room, fires are the most important potential hazards which should be noticed.5 In addition, safety issues associated with fires is 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 re-providing damaged equipments.6 Hospital Administrators in the U.S (United states of America) have estimated that about 100 fires occur annually in their hospitals OR which averagely 10 to 20 cases lead to severe injuries and 1 to 2 cases result in death.7 in Iran, we have no published official statistics or referral source to identify operating room fires, but it doesn’t 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 won`t be dangerous. But 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 provides the raw material for the fire. Using light sources which radiates high amount of energy and heat such as lasers, light sources, fiberoptic 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.8 unfortunately, the issue of safety for fires in the OR is not still a matter of discussion at the top of priorities.9 That might be due to misconceptions of the authorities about the low probability of an incident such as fires in a hospital operating room.10 In order to prevent fires during surgery, every operating room staff should take special responsibility. It requires knowledge of all staff and a well-organized team work.11 Related studies have shown that the most hospital staff especially in an operating room, have little knowledge about fire prevention and control. In a study by Davoodian Talab and collogues (2012) about staff knowledge in Shiraz Hospitals, It was found that approximately 50% of staff had no enough knowledge about fire control.12 Safavi and colleagues (2011) 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 operating room has been in the preparation stage. These factors of safety includes assessment of ventilation and temperature, checking oxygen bar, inlet and outlet valves of anesthesia machine, and so on.13 based on all these evidences, if the OR personnel have enough knowledge about sources of fire, it`s prevention, and methods of control, further injuries and damages can be avoided. Therefore, this study was designed to assess knowledge of operating room staff about sources of fires, its prevention, and control in selected hospitals affiliated to Isfahan University of Medical Sciences.
METHODS:
this study is a descriptive analytical design with cross sectional approach in which researchers evaluate the level of operating room staff knowledge including operating room technician, recovery nurse, anesthesia technician, non-specialized 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 operating room, having at least one year of job tenure, and Willingness to participate. All who were not eager to participate, failed to fill out the questionnaire, and inexperienced ones such as undergraduate students and first year residents were excluded. Data were collected by means of a three part questionnaire with 28 closed questions, in which the first section includes gathering demographic variables; 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 was based on four alternatives that respectively were: I`m completely aware of (4), I am quite aware of (3), I have little knowledge (2), and I do not know (1). 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 10 subjects. Questionnaires were filled out by subjects after signing the informed consent. Data were analyzed using SPSS version 17; descriptive statistics including mean, standard deviation, frequency distribution; and inferential statistics such as chi-square, t-test, ANOVA and Pearson correlation coefficient. All analyzes were performed at the significance level of (0/05).
RESULTS:
In this study, 257 cases of operating room personnel employed in selected hospitals affiliated to Isfahan University of Medical Sciences participated. 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 operating room technician and the lowest employment rate in 7 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 (the value=3). The difference was considered statistically significant (P<0/05). So 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).
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 (P=0/093) and methods of control (P=0/139) has been increased.
Table 1: Frequency distribution of demographic characteristics
|
(%)Frequency |
Criteria |
(%)Frequency |
Criteria* |
|
|
Profession |
|
Gender |
|
(4/5%)14 |
Surgeon |
(63%)162 |
Female |
|
(14%)36 |
Surgery resident |
(4/30%)78 |
Male |
|
(7/2%)7 |
Anesthesiologist |
|
Age |
|
(4/7%)19 |
Anesthesiology resident |
(7/30%)79 |
30-20 |
|
(6/36%)94 |
Operating room technicians |
(37%)95 |
40-31 |
|
(9/17%)46 |
Anesthesia technician |
(1/17%)44 |
50-41 |
|
(9/10%)28 |
Recovery nurse |
(7/2%)7 |
>50 |
|
(1/5%)13 |
Other |
|
Hospital |
|
74/7(76/10) |
Job tenure |
(14%)36 |
Chamran |
|
(2/41%)106 |
<10 |
(1/31%)80 |
Kashani |
|
(23%)59 |
20-11 |
(3/32%)83 |
Alzahra |
|
(1/10%)26 |
>20 |
(3/18%)47 |
Feiz |
|
|
|
(3/4%)11 |
Imam Musa Kazim (As) |
* Some of the participants’ data have not been fully completed
Table 2: Descriptive statistics of knowledge about fires, prevention, and control
|
Factors |
Frequency (%) |
Mean(SD) |
P-Value* |
|
|
Knowledge of fire resources and prevention |
3≥ |
66% |
)67/0(71/2 |
000/0 |
|
3< |
34% |
|||
|
Knowledge of fire control |
3≥ |
70% |
)71/0(62/2 |
000/0 |
*Binominal Test
Table 3: Comparing level of staff knowledge about fire resources and prevention based on variables
|
Variables |
Mean(SD) |
P-Value |
Variables |
Mean(SD) |
P-Value |
|
Gender |
|
|
Profession |
|
|
|
Female |
)69/0(73/2 |
313/0 |
Surgeon |
)70/0(72/2 |
000/0 |
|
Male |
)66/0(64/2 |
Surgery resident |
)56/0(35/2 |
||
|
Age |
|
046/0 |
Anesthesiologist |
)48/0(28/3 |
|
|
30-20 |
)69/0(63/2 |
Anesthesiology resident |
)83/0(84/2 |
||
|
40-31 |
)68/0(73/2 |
Operating room technicians |
)67/0(75/2 |
||
|
50-41 |
)67/0(70/2 |
Anesthesia technician |
)54/0(85/2 |
||
|
>50 |
)55/0(53/2 |
Recovery nurse |
)63/0(67/2 |
||
|
Hospital |
|
|
Other |
)52/0(60/1 |
|
|
Chamran |
)80/0(66/2 |
026/0 |
Job tenure |
|
017/0 |
|
Kashani |
)67/0(58/2 |
<10 |
)65/0(60/2 |
||
|
Alzahra |
)70/0(73/2 |
20-11 |
)72/0(94/2 |
||
|
Feiz |
)47/0(82/2 |
>20 |
)48/0(72/2 |
||
|
Imam Musa Kazim (As) |
)45/0(22/3 |
|
|
Table 4: Comparing level of staff knowledge about fire controlling methods based on variables
|
Variables |
Mean(SD) |
P-Value |
Variables |
Mean(SD) |
P-Value |
|
Gender |
|
|
Profession |
|
|
|
Female |
)73/0(60/2 |
711/0 |
Surgeon |
77/0(54/2 |
000/0 |
|
Male |
)70/0(64/2 |
Surgery resident |
)64/0(43/2 |
||
|
Age |
|
037/0 |
Anesthesiologist |
)46/0(36/3 |
|
|
30-20 |
)72/0(52/2 |
Anesthesiology resident |
)75/0(89/2 |
||
|
40-31 |
)71/0(64/2 |
Operating room technicians |
)71/0(57/2 |
||
|
50-41 |
)71/0(77/2 |
Anesthesia technician |
)66/0(76/2 |
||
|
>50 |
)46/0(66/2 |
Recovery nurse |
)62/0(63/2 |
||
|
Hospital |
|
|
Other |
)32/0(52/1 |
|
|
Chamran |
)73/0(52/2 |
028/0 |
Job tenure |
|
048/0 |
|
Kashani |
)67/0(61/2 |
<10 |
)69/0(55/2 |
||
|
Alzahra |
)80/0(54/2 |
20-11 |
)64/0(66/2 |
||
|
Feiz |
)56/0(73/2 |
>20 |
)78/0(79/2 |
||
|
Imam Musa Kazim (As) |
)60/0(23/3 |
|
|
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 non-specialized 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) (Table 4).
DISCUSSION:
fires in the operating room is one of the extremely dangerous events which can have catastrophic consequences.14,15 Knowledge about fires, prevention and control is essential for every hospital staff, so that this event can be wisely managed.16 As the results of the present study shows, staff knowledge about fires, prevention, and control is less than the average, which is consistent with other similar studies in our country. Mehdi nia and collogues (2011) designed a study to determine fires risk in Qom hospitals based on Fire Risk Assessment Engineering Method in order to develop a program to enhance 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 worsens the situation. So, 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 equipments, and also financial losses. Therefore, changes in system approaches to improve safety are required.6 In contrast with the previous study by Mehdi nia, in a research of Mousavi et al (2011) to determine 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 physical environment. But still the minimum safety has been for personnel who require refreshing and increasing knowledge.17
Regarding assessment of staff knowledge about Fires, its Prevention and control, results of Bagheri et al (2007) shows 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.18
Davoodian talab et al (2012) found that regarding methods of fire prevention, 40/97% of the staff didn`t 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 have been lower than their knowledge regarding fire prevention methods which is exactly consistent with our results.12
Shahbazi et al (2012) 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 a 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 the present study. In addition, the lowest level of knowledge has been for non-specialized personnel. But in contrast with our result, the highest knowledge level has been for surgeon.19 Bruley (2004) found that Fire Prevention in the Operating Room can be possible by raising staff knowledge About potential hazards and effective team work.11 AORN guideline have specified that based on previous studies, all Fires in the operating room is 100% preventable. Staff knowledge is of the most issue for this purpose.5 Beyea (2003) has determined steps to prevent and control fires in the operating room. It includes: 1-staff knowledge about methods of fire control, 2- fire Control Process Optimization, and 3-reporting incidence of fires in operating room.20
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. Al the staff should be aware of their responsibility toward their profession, patients, equipments, and environment.
ACKNOWLEDGMENT:
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, Operating Room Supervisors, and all the operating room personnel who participated and answered questions honestly.
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Received on 19.09.2015 Modified on 10.10.2015
Accepted on 17.10.2015 © A&V Publications all right reserved
Asian J. Nur. Edu. and Research. 2016; 6(3): 342-346
DOI: 10.5958/2349-2996.2016.00064.1