Designation of operating rooms as "wet" locations could prevent electrical injury to patients, OR personnel

A frightening electrical injury to an operating room nurse highlights the need to update electrical safety policies for the operating room, according to the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

A change in electrical codes designating all operating rooms as "wet" locations could prevent such injuries, making the OR environment safer for patients as well as operating room personnel, according to the new report. The lead author was Dr. John H. Wills of University of New Mexico School of Medicine, Albuquerque.

Wet Conditions Lead to Electrical Risks in Operating Room

The injury occurred during a routine operation, when a nurse was asked to plug in a piece of equipment. There was water on the OR floor from the use of irrigation equipment. While kneeling on the floor with one hand on the plug of the equipment and the other hand on the electrical junction box, the nurse felt a powerful electrical shock traveled up her arm and into her jaw, knocking her backward. The injured nurse had a ruptured eardrum and missed two weeks of work due to vertigo.

An electrical safety evaluation found no malfunction in the surgical equipment, power cord, or junction box. The circuit breaker supplying power to the operating room had not tripped. Although no definitive cause of the accident could be established, it was likely related to the presence of liquid—from either from routine OR cleaning or the irrigation fluid—inside the junction box.

The circuitry in the 40-year-old operating room was fully compliant with current National Fire Protection Association (NFPA) electrical codes. Yet it lacked two features that would have prevented the injury: an interruptible power supply (IPS) or ground fault circuit interrupters (GFCIs).

In the past, when inflammable and potentially explosive anesthetic drugs like ether were used, all operating rooms had IPSs. As these drugs were replaced by newer, nonflammable anesthetics, electrical safety standards were changed to allow areas of the hospital to be designated as "dry" areas, if they were not normally subject to wet conditions.

Suggested Code Revision Could Make ORs Safer

"The designation of ORs as dry locations seems illogical to the minds of many anesthesiologists," according to the authors. Fluid spillage is common in many common operating room procedures—including procedures using irrigation equipment. Yet under the "dry" designation, many operating rooms function without electrical safety precautions that are standard in other settings. "It appears incongruous that GFCIs are required in home bathrooms and kitchens, but IPSs or GFCIs are not required in ORs," Dr. Wills and colleagues write.

In a recent review of standards, the NFPA proposed designating ORs as "wet" locations —although one key professional organization opposed the change. It is unknown whether the change will be incorporated in the latest revision of the NFPA standards, expected later this year.

In an accompanying editorial, Drs. Steven J. Barker and D. Jon Doyle echo the call to revise the codes. "It seems to us that anyone (or any agency) who believes that the OR is a 'dry' location has never spent any time in one," they write. "Yes, there may be ORs that can usually be kept dry. But 'usually' is not good enough for this situation, wherein the hazard is great and the precautions for avoiding said hazard are rather simple and inexpensive."