Sparking in needle cutter led to fire: PGI probe panel
Six-member committee rules out short-circuiting as the reason behind the fire.punjab Updated: Apr 18, 2018 10:37 IST
Four days after fire broke out in operation theatre (OT) 3 on the first floor of the Emergency block, adjacent to the Advanced Trauma Centre at the Post Graduate Institute of Medical Education and Research (PGIMER), a six-member committee headed by dean (research), Dr Arvind Rajwanshi, submitted its findings in connection with the incident here on Monday.
As per the report, “Due to sparking in a needle cutter, a baby resuscitator with high oxygen concentration in it caught fire. The fire further spread to the operation theatre.”
The report was submitted to PGI director Dr Jagat Ram. The committee has ruled out short-circuiting as the reason behind the fire.
- A portable fire extinguisher should be installed inside the operation theatre.
- Manual needle cutter should be used in the operation theatre/other areas of the hospital.
- Oxygen supply and other inflammable anaesthetic gases and fluid should be switched off when not in use.
- Gas-based flooding system should be installed in the OT to control fire effectively and minimise the loss of life and property.
- High pressure smoke exhaust fan with alternative power supply should be installed in the OTs and corridors for quick ventilation.
- The corridors and OT areas should be kept clear every time and the equipment which are not in use should not be stocked in the Operation Theatre Complex.
- As the OT 3 has a small area (21 x 17.5) and all the equipment including medical and para medical staff congested the space, hence,the area should be increased.
- A passage should be constructed connecting Emergency Operation Theatre Complex with Advance Trauma Centre from the back side of the Operation Theatre Complex.
Findings of the committee
“On April 11, at 9.30 pm, a caesarean section was going on at OT 3. After the delivery, the paediatrician resuscitated the infant and left the operation theatre along with the baby and a staff nurse. A few minutes before the incident, junior resident, department of anaesthesia, Dr Deepika, who was present in OT 3, smelled something burning,” mentions the report.
She noticed a spark in the needle cutter which was kept near the paediatric resuscitator.
“According to Dr Deepika, the paediatric resuscitator trolley corner caught fire, engulfing the entire OT within minutes . The patient was safely shifted from the operation theatre,” mentions the report. Two other staff members also corroborated the doctor’s version.
During the site inspection, the committee found that the wiring from the affected area to the main electrical junction box was intact ruling out the possibility of short circuit.
As per the report, the committee unanimously put forward the spark in the needle cutter in an oxygen-rich environment as the cause of fire.