Reducing the risk of oxygen-related fires and explosions in hospitals treating Covid-19 patients

On 24 April 2021, a disastrous fire in an Iraqi hospital took the lives of 82 people. Since the outbreak of the pandemic in March 2020, incidents of oxygen-related hospital fires in various countries around the world have caused over 200 deaths, the majority of whom were patients extremely ill with the novel Coronavirus. Fires involving medical oxygen are not a new phenomenon but are more common in the operating theatre where oxygen is routinely administered. In these settings, strict safety protocols are normally enforced and surgical staff are well trained in dealing with oxygen hazards. It appears that some hospitals may not have been fully prepared for the elevated risk of oxygen-related fire in intensive care units due to the high demand for oxygen therapy in severely ill Covid-19 patients. Indeed, gas producers and public health authorities were also slow to recognize and alert hospitals to the potential dangers. Oxygen is essential to life and generally makes up about 21 % of the gases in the air we breathe. Pure oxygen reacts with common materials such as oil and grease to cause fires, and even explosions, when released at high pressures. A leaking valve or hose, and openings at interfaces of masks and tubes, when in a confined space or where air circulation is low, can quickly increase the oxygen concentration to a dangerous level. Even a small increase in the oxygen level in the air to 24 % can create a fire hazard. In an oxygen-enriched environment, materials become easier to ignite and fires will burn hotter and more fiercely than in normal air. There is also a potentially heightened risk of using ethanol-based and organic solvents as cleaning agents in an oxygen rich atmospheres. This paper will provide an overview of oxygen accident scenarios that may be relevant for hospital intensive care units, with particular reference to recent events and similar accidents that have occurred in the past. The paper will recommend that hospitals recognize their chemical risks as part of their risk governance responsibility and assign chemical risk management a prominent role in their overall management. Investigation of dangerous events to extract causes and lessons learned should be utilized to highlight opportunities for prevention as well as emergency response. The industrial gas industry also needs to actively support hospitals in adoption of more rigorous risk management approaches, building on lessons learned in chemical process safety for managing flammable and explosive atmospheres.