The website of the Clinical Services Journal

Why aren’t surgical fires classed as a Never Event?

Nigel Roberts examines the evidence around the incidence of surgical fires, as well as current guidance to prevent associated harm. He considers whether surgical fires should be classed as a ‘Never Event’ and whether mitigating steps should be incorporated into the WHO surgical safety checklist

The research on the current three intra-operative ‘Never Events’ has bought to light another potential intra-operative ‘Never Event’ for discussion – surgical fires. ‘Never Events’ are defined as ‘Serious Incidents that are wholly preventable because guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers’.1

Early research by Bruley2 concluded that ‘surgical fires are a preventable hazard’, five years prior to the publication of the World Health Organization’s (WHO) surgical safety checklist. So why was the decision made not to class a surgical fire as a ‘Never Event’? 

Research suggests that the first recorded surgical fire, occurring on a patient as a result of the use of anaesthetic gases, goes as back as far as 1850 – when ether caught fire during facial surgery.3,4 However, surgical fires remain a significant safety issue today.

Log in or register FREE to read the rest

This story is Premium Content and is only available to registered users. Please log in at the top of the page to view the full text. If you don't already have an account, please register with us completely free of charge.
Register

Upcoming Events

Arab Health 2023

Dubai World Trade Centre
30th January - 2nd February 2023

Central Sterilising Club Annual Scientific Meeting

Crowne Plaza, Newcastle Upon Tyne
3rd - 4th April 2023

DECON UK 2023

Hilton Birmingham Metropole
18th April 2023

Infection Prevention and Control 2023

National Conference Centre, Birmingham
25th - 26th April 2023

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Upcoming Events

Arab Health 2023

Dubai World Trade Centre
30th January - 2nd February 2023

Central Sterilising Club Annual Scientific Meeting

Crowne Plaza, Newcastle Upon Tyne
3rd - 4th April 2023

DECON UK 2023

Hilton Birmingham Metropole
18th April 2023

Infection Prevention and Control 2023

National Conference Centre, Birmingham
25th - 26th April 2023

Access the latest issue of Clinical Services Journal on your mobile device together with an archive of back issues.

Download the FREE Clinical Services Journal app from your device's App store

Step Communications Ltd, Step House, North Farm Road, Tunbridge Wells, Kent TN2 3DR
Tel: 01892 779999 Fax: 01892 616177
www.step-communications.com
© 2023 Step Communications Ltd. Registered in England. Registration Number 3893025