THERE ARE CERTAIN FACTORS THAT MAY MAKE DIALYSIS clinics more susceptible to fire than other medical buildings are, but fortunately, fires at dialysis clinics are rare. On the oft chance that a fire does occur in a dialysis setting, it’s usually due to electrical systems such as air conditioners and space heaters, said Richard Bruner, divisional vice president of DaVERT (DaVita Village Emergency Response Team).
“Thankfully, the number of fires that have been started by dialysis-related machinery is very small,” Bruner said.
Laura Regis, RN, MSN, CNN, a consultant dialysis nurse who is also administrative director for a home dialysis program, said she does not believe dialysis clinics are more prone to fires than any other buildings are, but notes that if a fire does occur, evacuation can be challenging due to the large amount of patients who need assistance. Chemicals can also be an issue, but typically aren’t, she said.
“Hemodialysis clinics use chemicals for sanitizing water systems and some dialysis supplies that have an MSDS flammability rating of 2. Although these chemicals will readily combust during a fire, I do not know of any fire that was started due to these chemicals on site,” Regis said.
The biggest risk is when outside contractors perform repairs and renovations where “hot work”—such as welding or burning—is conducted without following proper procedure, according to Larry Park, vice president, Fresenius Medical Care North America.
“Another issue is outside contractors who do not secure the proper permits for ‘hot work,’” Park said. To prevent problems, outside contractors should receive additional training before work commences, and all permits need to be seen before work begins, he added.
Minimum Requirements
Minimum fire safety requirements for dialysis clinics are in place to ensure the proper operation of all fire detection, monitoring and suppression systems, as well as the proper operation of all exit doors, Park said.
As of Feb 2009, the Centers for Medicare & Medicaid Services (CMS) incorporated mandatory compliance with the 2000 edition of the Life Safety Code of the National Fire Protection Association. The regulatory changes include minimum requirements for the physical structure and environment of new and existing clinics, and staff performance, according to Regis. The physical requirements address exits, sprinkler systems, door and hallway measurements, emergency lighting, fire alarms, extinguishers, fire walls, smoke barriers and fire-rated furniture.
“Facilities will need to review these requirements and have a plan to bring their clinics into compliance if they have not already done so,” Regis said. New clinics are now subjected to a full-day fire code inspection in addition to the initial nurse survey to meet Conditions for Medicare Coverage, she added.
“CMS does not dictate how often patient training should occur, just that the patients must have sufficient knowledge of how to disconnect themselves from the machine and evacuate the facility,” Regis said. “For whatever reason, during patient surveys it has been my experience that most patients do not even recall this training. Dialysis management needs to be committed to this process and coach staff to make the patient education a visual experience and meaningful.”
Indeed, dialysis facilities must comply with the applicable provisions of the 2000 edition of the Life Safety Code of the National Fire Protection Association, and each clinic must comply with federal regulations from CMS, and regulations imposed by state and local authorities, Bruner noted. These regulations include appropriate placement, maintenance and testing of fire extinguishing systems, and place more emphasis on sprinkler systems and fire-rated walls and doors, he added.
“For new construction of dialysis clinics, many new fire-safety standards have been recently added to the regulations, Bruner said. “These new regulations have placed more emphasis on sprinkler systems and improvements to fire-rated walls and doors.”
Each facility is required to have a formal fire-safety and emergency-evacuation plan, including evacuation floor plans, identification of an appropriate evacuation route and an alternative route, identification of a location outside of a facility to which patients and teammates will be evacuated, and a checklist to ensure all proper procedures are followed and formal in-servicing of patients and teammate, Bruner added.
