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September 16, 2003

Bulletin: AHA-ASHE-CDC collaborate with fire safety experts on alcohol-based hand rubs – code changes likely

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Sincerely,

Gina Pugliese, RN, MS, editor
Vice president, Premier Safety Institute

AHA-ASHE-CDC collaborate with fire safety experts on alcohol-based hand rubs – code changes likely

Implementing handwashing with alcohol-based hand rubs as recommended by the Centers for Disease Control and Prevention (CDC) and as required as a new 2004 Joint Commission on Accreditation of Healthcare Organizations Safety Goal has been a challenge for healthcare practitioners. Specifically, existing national and local fire codes do not permit placement of flammable liquids such as the hand rub dispensers, in hallways, a convenient location believed to promote handwashing compliance.

On July 22, the American Hospital Association (AHA) and CDC co-hosted a National Stakeholders Meeting on Alcohol-based Hand-Rubs and Fire Safety in Health Care Facilities with representatives from healthcare and fire safety professional groups to review scientific fire risk data and existing fire codes. The agenda included discussion of two important studies:

  • Survey of fires in hospitals: No fires were reported to be related to the use of alcohol-based hand rubs from a survey of 840 hospitals in 50 states representing 1,430 hospital-years use of alcohol-based hand rubs. (Boyce J, Pearson M. Low frequency of fires from alcohol-based hand rub dispensers in healthcare facilities 2003; 24(8):619.)
     
  • Fire modeling analysis: The American Society of Healthcare Engineering (ASHE) commissioned Gage-Babcock & Associates, Inc. to perform a study of how alcohol-based hand rubs will react to a fire in a typical patient care environment.

Executive summary: Based on fire modeling, the results indicated that dispensers could be safely installed in corridors as long as: (1) the volume of the hand rub was 1.2 liter or less; (2) the dispensers were not installed too closely together along the corridor and, (3) the dispenser installation over carpeting is avoided until further testing is completed. (See full Fire modeling analysis full report and Fire modeling analysis Appendix B for details.)

As a first step, the AHA and CDC have launched a campaign to increase the use of these hand hygiene products in locations that are currently permitted by most local fire marshals, such as, patient rooms, treatment rooms, suites and other appropriate areas within a facility, but not in egress corridors. According to the AHA advisory, facilities are being urged to institute hand hygiene campaigns to educate staff on the serious problem of healthcare-associated infections (HAI) and the impact of hand hygiene on reducing infection.

Additionally, AHA and CDC are working with fire safety groups to have exceptions made to current codes in light of the fire modeling findings noted above. They are also committed to finding a solution to promoting the use of alcohol-based hand rub products without jeopardizing safety and increasing fire risk. This includes:

  • Conducting further studies on how hand rub dispensers can be safely installed.
  • Working together to revise fire codes that would allow appropriate placement of dispensers to increase use of these products, thereby reducing HAI.

Until exceptions to fire codes are made, healthcare facilities should follow the directives of their local fire marshal. When changes do occur, local fire marshals will have to review and adopt the changes within their jurisdiction as appropriate.

Additional information related to the meeting is available below, and updates will be provided on progress related to code interpretation.

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