Aug 17 2017

Locks on Operating Room Doors

Category: Door Locks,Operating Room,Questions and AnswersBKeyes @ 12:00 am

Q: Our operating rooms were constructed with deadbolt locks on each surgical room. I’m told they did this to keep someone from entering the room during a case. Since this is most likely the path of egress I can’t see this being okay by the LSC. Your thoughts?

A: I would agree with you… But there are quite of few variables here. First of all, is the OR area a suite of rooms? If so, then the doors to the operating rooms do not have to latch, and a thumb-turn handle on the egress side to unlock a dead-bolt would be permitted since there is only one action to operate the door (see of the 2012 Life Safety Code). But, if the operating rooms are not in a suite, then no, you would not be able to have dead-bolt locks because the doors would have to latch (since they open onto a corridor) and that would mean there would be two actions to operate the door: 1) To unlock the dead-bolt, and 2) Unlatch the latchset hardware.

Now section of the 2012 Life Safety Code modified some of that and says existing doors are permitted to have two releasing operations to a room serving not more than 3 occupants, provided it does not require simultaneous operations to unlock the door. But… the typical operating room serves more than 3 occupants, so I don’t see that section working for you.

I would say it boils down to whether or not the OR is a suite of rooms. If yes, then the dead-bolt locks may stay if there is only one action to operate the door. If no, then you have to remove the dead-bolt locks.

Jun 07 2017

Water-Mist Fire Extinguishers in the ORs

Q: Our facility recently installed water-mist fire extinguishers in all of our operating rooms, which is the sole fire suppressant. Is this acceptable?

A: It could be okay to have water-mist portable fire extinguishers in the operating rooms, provided there is a Class B:C fire extinguisher within 50 feet travel distance from inside the ORs.

The typical water-mist fire extinguisher is rated for Class A and Class C fires; both of which are possible in an operating room. But what about Class B fires? Most operating rooms are known to have flammable liquids, and a Class B fire extinguisher would be required. NFPA 10 says the travel distance to a Class B fire extinguisher is either 30 feet for low capacity extinguishers and low hazard areas, or 50 feet to moderate capacity extinguishers and low to moderate hazards. The OR could be rated as a low hazard area, but typically a Class 10-B CO2 extinguisher qualifies for a 50-foot travel distance and a Class 5-B CO2 extinguisher qualifies for the 30-foot travel distance.

But I would suggest that your Infection Control people weigh-in on this debate because the typical water-mist fire extinguisher consists of tap water, pressurized with compressed air. That is a recipe for a breeding-ground for germs. I’ve seen some hospitals use distilled water in their water-mist fire extinguishers and pressurize it with nitrogen, to discourage germ growth. But the IC folks should have a say in this because a water-mist fire extinguisher would be expected to be used on a patient who is on fire, in surgery with an open cavity.

Here is what I would suggest:

  • Remove the water-mist fire extinguishers from the operating rooms.
  • Install 10-lb Class 10-B:C CO2 portable fire extinguishers inside each OR. This will handle all Class B and Class C fires that may occur in the OR. Discharging a CO2 extinguisher in an operating room would not be detrimental to the patient.
  • Rely on the staff having sterile water in the operating field to extinguish any Class A fires that may occur. Sterile water dosed on a patient would not be detrimental to the patient.
  • Definitely remove all Class ABC dry chemical fire extinguishers from the surgery department, so they will not be accidentally used on a patient. Nearly the last thing you want is dry powder sprayed into an open cavity of a patient during surgery.

You say the water-mist fire extinguishers are the sole fire suppressant. Does the OR have water-based fire protection sprinklers? If not, why not? There have been some mistaken ideas that water drips from sprinklers and some surgeons ‘prohibit’ sprinklers in their ORs. While it is true that a defective sprinkler could drip water, it is extremely rare and unlikely. Nevertheless, a pre-action sprinkler system would be an acceptable answer as the sprinkler pipe over each OR would be dry.

Aug 04 2014

Operating Room Entrance Doors

Category: Doors,Operating Room,Questions and AnswersBKeyes @ 6:00 am

Q: Concerning latching hardware for a surgical suite, I could not locate any exceptions in the Life Safety Code to the positive latching requirements concerning operating room doors. From an infection control standpoint, the doctor having to handle a lever after scrubbing would not be desirable. Since the operating room is positive pressure, and the doors swing into the room, the positive pressure keeps the doors in a closed position full time. Are there waivers issued for these situations?

 A: Entrance doors to operating rooms that positively latch can have hardware devices that resemble ‘paddles’ and are easily actuated by elbows, hips or shoulders. The physicians and nurses do not have to touch the paddles with their hands, which may be considered sterile from scrubbing. The bigger question to consider in this scenario is do the entrance doors to the operating room actually have to positively latch? This can be easily answered by determining if the Surgical OR area is a suite of rooms or not. If the OR area is a suite, then the entrance doors to the operating rooms do not have to latch. However, if the OR area is NOT a suite, then the entrance doors to the operating rooms must latch since they are doors that open onto an exit corridor. The OR area is either a suite or it is a series of exit access corridors. The advantage of a suite is there are no requirements for corridors inside the suite because it is a room. Therefore, what looks like a corridor is actually a communicating space and the minimum widths pertaining to aisles in a communicating space (see section of the 2000 LSC) are required to be maintained (28” for existing and 36” for new). That means the restrictions about storing items (such as medical equipment and non-combustible supplies) in the corridors no longer applies. Also since there are no corridors, there are no requirements for corridor doors, which means if there are doors to the inner-rooms (other than doors to exits or hazardous rooms), they do not have to latch. This is a huge advantage for those high-acuity areas such as ERs and ICUs where staff needs to have access to their patients quickly. As far as waivers are concerned, it would be very unlikely that the Centers for Medicare & Medicaid Services (CMS) would grant a waiver for a corridor door to an operating room that is required to latch. All waivers and equivalency requests must be submitted through your accreditation organization or state agency, who then submits them to the appropriate CMS regional office for approval. Only CMS is able to approve waivers or equivalency request, according to the recent proposed rule on the adoption of the 2012 edition of the LSC.

Mar 11 2013

Operating Room Doors

Category: Doors,Operating Room,Questions and AnswersBKeyes @ 5:00 am

Q: We just had an outside company update our SOC (Statement of Conditions) and even though we haven’t changed anything in 20 years he noted what he considered to be a deficiency.  The doors into the OR rooms do not have positively latching hardware even though they come off an egress hallway. Is there an allowance for usage vs. Life Safety Code? Latching all of the OR doors would become more of an infection control issue since staff would have to reach out and grab a door knob potentially infecting theirs hands instead of backing into the rooms. Is this something our AHJ would have discretion over? Unless there is some way to break it up the area is too big to be considered a suite.

A: You mentioned that the entrance doors to the operating rooms are from an egress hallway, and the Surgery department does not qualify as a suite-of-rooms since it is too large in square footage.  Therefore, the door to the operating rooms would have to positively latch, since they open onto the corridor.  But, you asked if there are “allowances” in the Life Safety Code that would allow these doors to continue to be non-latching. Yes, there are, but they are not always the best options to take. Here are my suggestions on how to resolve this problem. First, I would do whatever I could to make the OR area qualify as a suite-of-rooms. Work with your architect to design a way to create walls and doors to lower the total square footage to no more than 10,000 square feet. Secondly, consider requesting an equivalency from your authority having jurisdiction on a suite of rooms that is too large (see Q&A on over-sized suites of rooms, posted February 28, 2013). Thirdly, if the two suggestions above are not an option for you, then you MUST install positive latching hardware on the doors. This is not as bad of an option as you implied. I disagree that positive latching hardware would be an infection control issue, as there are numerous options in hardware designs that area available which are actuated by elbows and hips. Positive latching hardware is on thousands of operating room doors and there is no report or indication that it is an infection control issue.