Requirements for what type of fire extinguisher to place in an operating room (OR) remains a hot topic of discussion among health care facilities professionals. Fire extinguishers  act as a first line of defense for fires of limited size, and given a patient’s vulnerable state during a surgical procedure, rapid extinguishment of a fire is critical for safety. For this reason, among others, it’s vital that special consideration is applied to ensure the right extinguisher is selected for OR spaces.   

Evaluating fire extinguishers using code requirements

NFPA 101®, Life Safety Code®, 2012 Edition, requires portable fire extinguishers be provided in all health care and ambulatory health care occupancies. The Life Safety Code points to NFPA 10, Standard for Portable Fire Extinguishers, 2010 Edition, as the standard to follow when selecting portable fire extinguishers.

NFPA 10 requires fire extinguishers to be selected based on the types of hazards present in the area, and the type of fire extinguisher to provide in a particular setting is dependent on whether sprinkler protection is provided in the area. Most ORs contain the risk of Class A fires (fires that involve wood, cloth, paper, rubber and many plastics); Class B fires (fires that involve flammable liquids, flammable gases and combustible liquids); and Class C fires (fires that involve energized electrical equipment).

NFPA 99, Health Care Facilities Code, 2018 Edition, which is not currently enforced by the Centers for Medicare & Medicaid Services, added language that stipulates clean agent or water mist fire extinguishers be used in ORs. An annex note goes on to state that dry chemical extinguishers should not be provided in ORs, and that clean agent extinguishers should have a Class A rating. The annex note was further modified in the 2021 edition to state that carbon dioxide (CO2) extinguishers share the electrical nonconductive properties of clean agent and water mist extinguishers and could therefore be used in lieu of a clean agent extinguisher. One caveat, however, is that CO2 extinguishers do not contain a Class A rating.   

Pros and cons of common fire extinguisher options

Multipurpose dry chemical extinguishers are the most common fire extinguishers in use today  and generally are listed for use on Class A, Class B and Class C fires. However, this extinguisher is not appropriate for use in an OR because the extinguishing agent particulates could come in contact with a patient’s surgical opening.

Water mist fire extinguishers are one of the two types of extinguishers NFPA 99-2018 specifically mentions as being permitted in an OR, but it does pose infection control issues. A recently raised concern is that, over time, the distilled or ionized water used in the water mist extinguisher could become a breeding ground for bacteria. Also, water mist extinguishers are only rated for Class A and Class C fires and do not provide protection from Class B fire hazards. 

CO2 extinguishers do not leave behind particulates, but they are rated only for Class B and Class C fires. There is also the concern that a CO2 extinguisher poses a risk of freezing the skin if the nozzle is too close to a patient when it is discharged. Note that a CO2 extinguisher meets the NFPA 10 definition of a clean agent fire extinguisher, which is “electrically non-conducting, volatile or gaseous fire extinguishant that does not leave a residue upon evaporation.” 

There are clean agent fire extinguishers on the market that are listed for Class A, Class B and Class C fires. A clean agent extinguisher with a Class A rating is approximately 12-15 pounds and costs substantially more than CO2 extinguishers. If a clean agent fire extinguisher is used to protect against Class A fire hazards ensure it is listed for 2-A, as this is the minimum rating for a single extinguisher for Class A fire hazards.   

A common approach to providing fire extinguishers in ORs is to provide a CO2 extinguisher in each room and provide multipurpose dry chemical extinguishers in the corridor outside the room, with a maximum travel distance of 75 feet to all locations in the OR. Athough this approach does satisfy the code-required Class A, Class B and Class C fire hazard protections,  in reality, it does not provide viable protection for the Class A hazard since the multipurpose extinguisher cannot be used near the patient. One method of addressing this in the OR is to open a new bottle of saline solution for each procedure and pour it into a basin with a sponge. If a fire were to occur on the patient drapery, the sponge could be removed from the basin and the water squeezed over the fire.     

Firing up the decision-making process

When determing which fire extinguishers to provide in this sensitive but necessary medical arena, it is highly recommended to involve all stakeholders (infection control, OR staff, facilities management, etc.,) in the decision-making process. It is crucial to have all team members discuss the risks associated with the use of fire extinguishers in the OR, as well as the best solution to mitigate hazards. It is also recommended to perform a risk assessment to document the types of fire extinguishers selected for the OR and the reasons why. Once  the fire extinguisher type or types are  selected, it is imperative that staff are properly trained on their use.