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Surgical suites across the nation are ablaze this week as rumors of a newly-formed Joint Commission task force has all parties involved sweating in anticipation of the almost-certain visits and inspections that will result. This comes in light of a dramatic rise in operating room fires over the last 6 months. Several hospitals are under scrutiny and are being placed on probationary status.

firesOne such hospital in the Pacific NW has seen a 10-fold increase in OR fires in the 3 weeks since their initial Joint Commission visit. While the hospital was praised for excellent clinical care and patient satisfaction during that visit, it was cited heavily for improper OR attire and breaches of dress code. The existing dress code is now being more strictly enforced and several new policies have also been enacted. A properly dressed OR provider must now comply by wearing at a minimum:

-Hospital issued scrub suit. Top must be tucked into pants. Pants must be tucked into socks
-Bouffant cap covering the ears and hair (must extend down over the eyebrows)
-Beard and mustache cover
-Surgical mask over mouth and nose (and over beard cover)
-Mask cover (to cover the beard cover and mask)
-Goggles that completely cover the eyelashes (the forgotten hair of the face)
-Special surgical dickey to cover any wayward chest or neck hair
-Warm-up jacket, fully buttoned and covering the wrists
-Surgical “overcoat” to wear over the warm-up jacket
-Full shoe covers extending up to the knees
-Undergloves (never to be taken off for risk of shedding squamous cells into the surgical
field)
-Overgloves which may be changed as provider sees fit

A “No Tolerance” approach has been adopted, and upon first violation, all privileges to scrub suits are rescinded. The violator must then wear a newly-fashioned “bunny suit” that is identical to the traditional one given to equipment vendors and fathers-to-be in the L&D suite with the following additional features:

-integrated full faceshield, head, and neck cover with actual bunny ears
-“footie” style full shoe covers

While wearing this special suit, no movements are permitted throughout the surgical sterile areas unless completed by hopping.

When questioned about the cause of this uptick in fires at his hospital, Dr. Gazzi, Head of Perioperative Services remains baffled. “You know, I’ve been here for 20 years, and in that time we’ve had a few fires here and there, but — expected stuff. Like, an airway fire in an ENT laser case, or the occasional drape that is ignited when the surgical intern puts down the laparascope and forgets the light source is at 100%. These recent fires have been quite the contrary – most have been a result of spontaneous combustion. We’ve lost 3 of our anesthesia residents in the last week! One spontaneously combusted during a case, only to be discovered at the end of the case when the surgical drapes came down. Another melted into a liquid puddle that was found during turnover by the cleaning crew. The third is in critical condition with second degree burns after a near-combustion event. It has especially been hard on the Pediatric Division, where two of the these incidents occurred during neonatal surgeries that required the room temperature to be above 75 degrees.”

We attempted to get a representative from the Joint Commission to comment on these deaths, but his answer was muffled by the beard cover, mask, and mask cover he was wearing.

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