Bed safety: preventing fires caused by hospital beds; Hot tips for clinical staff and bed-maintenance personnel.

Flames in a resident's room trigger a heat detector, setting off a fire alarm. A member of the nursing home's housekeeping staff alerted by the fire alarm, sprays afire extinguisher into the resident's room, which is filled by a dense cloud of smoke. A senior staff member who had heard a "pop" sound emanate from the room yells "Is anybody in there?" No one answers. Most of the residents are evacuated from the building when firefighters arrive. The fire was held to the room of origin as a result of staff efforts at extinguishment. Smoke scars the walls of the damaged room.

The 73-year-old resident with Alzheimer's disease, Adele, had moved her nightstand as she lay in bed. It jostled the bed's power cord at the electrical outlet. Sparks shot out of the plug and outlet igniting a sheet at the head of the bed. Flames raced down the bedding and covered Adele's body. She sustains second- and third-degree burns over 98 percent of her body. Ambulance attendants report that her skin was peeling from her feet to her waist. Adele dies a few hours later at a nearby hospital. The medical examiner determines that the burns played a direct role in her death.

The fire marshal's investigation concludes that preexisting power cord plug damage caused the sparking when the cord was tugged. The resident's loved ones consult an attorney, the facility is slapped with a lawsuit, and the insurance impact from the fire is not yet clear.

Resident safety is integral to providing quality nursing home care. Fires pose true threats to nursing homes, as well as their residents and staff. To receive government reimbursement, nursing homes must comply with several telephone books' worth of federal regulations and guidance. One says facilities must have emergency plans and procedures to meet all potential emergencies and disasters, including fires. With lives and property at stake, take steps now to prevent bed fires in your facility.

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The Food and Drug Administration (FDA) reported in a Public Health Notification (www.fda.gov/cdrh/safety/bedfires.html) that it had received 95 reports from 1993 to 2003 of fires involving electrically powered hospital beds. Seventy-five percent of the fires were associated with such causes as failed motor starting capacitors, overheated motors, arcing from ill-fitting or damaged plugs, missing ground pins, fluid leaks that damaged the circuit boards, missing components in the wiring, poor maintenance, or failure to heed manufacturers' warnings. At the authors' request, the FDA searched its Manufacturer and User Facility Device Experience (MAUDE) database (www.fda.gov/cdrh/maude.html) using the keywords "fire," "smoke," "spark," "burn," "flame," and "ignite," and reported another 34 such incidents from January 1, 2004, to April 1, 2006.

Awareness of fire risks and precautions related to electrically operated beds is important to protect nursing home residents and staff against the risk of injury or death and to prevent significant property damage. To prevent such incidents, the authors offer safety tips that apply to all electrically powered healthcare beds, but may be particularly useful for older bed models. The tips are directed toward clinical staff and staff responsible for bed maintenance. This discussion assumes that the nursing home already has fire-prevention and behavioral policies in place (e.g., smoking in bed; lighter, candle, and match use). Safety tips supplied do not address any fire risks posed by oxygen administration to a nursing home resident while in bed.

Safety Tips to Prevent Fires Caused by Hospital Beds

Clinical staff. When plugging in a bed, visually inspect the bed's power cord for damage from, among other possibilities, use, age, crushing, pinching, shearing, cutting, cleaning solutions, bed movement, human and equipment traffic, and furniture placement (e.g., positioning a nightstand too close to a bed's power cord). Cord insulation should be intact and without evidence of bulging, stretching, crimping, cracking, or discoloration, especially at the ends, where the cord is attached to the plug body and to the hospital bed.

After inspection, connect the power cord directly into a wall-mounted outlet that is in good working order and capable of accommodating a heavy-duty or hospital-grade plug. The plug body, wall outlet, and wall plate should not be cracked or chipped. The plug should fit tightly into the outlet. The plug blades should be securely retained in the plug body. Any ground pin should be intact and secure. Do not connect the bed's power cord to an extension cord or to a multiple-outlet strip because they are highly vulnerable to physical damage that can cause fires. If use of extension cords or multiple-outlet strips cannot be avoided, choose only heavy-duty or hospital-grade connectors approved by the facility's engineering department. Only properly trained electrical-maintenance personnel should install extension cords and multiple-outlet strips. Mount multiple outlet strips on a fixed object (e.g., an equipment cart) to reduce risk of liquid spills and physical damage. Also protect multiple-receptacle outlet boxes from the risk of liquids spills and physical damage. All extension cords and multiple-outlet strips should be tagged and inspected routinely.

Do not cover the bed's power cord with a rug or carpet. Doing so may impede normal air flow which, in turn, can lead to greater heat buildup. Covered power cords also are more likely to be walked on or have furniture placed directly on them. To avoid this, advise bed-maintenance staff to place cords in low- or no-traffic areas.

Ask appropriate staff to inspect all parts of the hospital bed frame, the motor and hardware, the mattress, and the floor beneath and near the bed for dust and lint buildup, which may clog the motor. Clinical staff should ask housekeeping to clean if necessary.

Test the bed to ensure that it moves freely to its full limit. In many facilities, wall-mounted outlets are located directly behind the hospital bed. Confirm that the bed's vertical motion does not interfere with the bed's power cord or plug. In addition, do not thread the bed's hand control cable or any other power cords through the mechanical parts of the bed or bedrails where normal bed movement may damage or cut the cable.

Examine the bed's hand and panel controls, including patient lockout features, to ensure that the bed is working properly and can move freely without damaging any cords. Look for signs of cracking or other damage to the controls so liquids or other conductive material will not penetrate to the switches.

Check bed-occupancy monitors and all other equipment in the resident's room that has plug-in power supplies for indications of overheating or physical damage. For example, make sure that the power supplies are plugged into a wall socket where they will not come in contact with bedding or bedclothes. If overheating is suspected, follow facility policy for fire safety and, if necessary, move the resident to a safe area.

Other precautions that may prevent hospital-bed fires include informing bed-maintenance personnel of any unusual equipment sounds, burning odors, or bed-movement deviations, and following all manufacturers' recalls and safety notices.

Bed-maintenance staff. In addition to the recommendations for clinical staff, bed-maintenance personnel should regularly perform routine electrical safety testing according to the manufacturer's recommendations and facility protocol.

When the bed has a power cord with a three-prong plug, be sure that the electrical resistance of the safety ground conductor and the level of leakage current (i.e., line conductor to safety ground and neutral conductor to safety ground) meet applicable standards. Any protection afforded by the bed's ground pin is negated if the receptacle is not properly grounded. Beds with two-prong power cord plugs are considered safe if they are approved as a Class II (i.e., double-insulated) device by a nationally recognized testing laboratory such as Underwriters Laboratories (UL). Major medical device standards require devices with double-insulated construction be marked with "Double-Insulated," "Double Insulation," or the international symbol for such. These markings appear on the device body (e.g., frame or controls enclosure).

Personnel responsible for bed maintenance should check all electrical outlets, including accessory outlets mounted on beds, for functionality, physical integrity, and cleanliness. Use hospital-grade outlets mounted with the ground pin or neutral blade up to ensure that any metal that may drop between the plug and the wall will likely contact an unenergized blade.

In addition, examine the bed's power cord along with any other power cords connected to medical electrical equipment in the resident's room to substantiate that heavy-duty or hospital-grade plugs are used, contact pins are straight and secure, and strain reliefs are adequate. If repairing or replacing a power cord, only use one that meets the bed manufacturer's requirements. Additional bed-maintenance safety tips include, but are not limited to:

* Assessing battery-powered beds for hot spots in power cords, batteries, voltage inverters, and battery chargers.

* Maintaining and servicing the bed motors and mechanisms in keeping with the manufacturer's recommended service plan to avoid stalling and overheating.

* Examining all gas and liquid fittings so they remain in good condition, without leaks or other signs of damage.

* Confirming that all switch-type circuit breakers move freely.

* Matching the ratings of external fuses with device requirements and stocking appropriate spare fuses, since an incorrect fuse can negate its protective function, leading to equipment damage and/or fire.

* Checking bed and all other electrical power cable connectors in the resident's room to make certain that they are in good condition, free of moving bed parts, and off the floor where possible. Locating power cords in low- or no-traffic areas and taping then down only as minimally necessary may avoid a tripping hazard when positioning power cords on the floor is unavoidable.

* Undertaking an inventory of equipment for beds with 120-volt AC patient and clinician controls. These controls are vulnerable to liquid spills that can lead to bed fires. Contacting the bed manufacturer is recommended for options to convert the control to a low-voltage powered control. Regularly performing maintenance will prevent possible electrical arcing or overheating when replacement or conversion of such beds is not a reasonable option.

* Following all manufacturers' recalls and safety notices.

In Closing

An effective risk-management program requires the identification of healthcare technology risks, such as those related to electric hospital beds, along with the design and implementation of corrective or preventive actions throughout a facility. One area of concern involves minimizing the potential for bed fires as it relates to the electric bed itself. Although such fires are relatively rare, this article serves as a guide not only for nursing home administrators, facility engineers, directors of nursing, and medical directors, but for all attending physicians, staff nurses, nurse practitioners, and physician assistants motivated to provide quality care to the residents for whom they are responsible. The specific safety tips presented will help readers better understand of how to prevent such incidents. Like lawsuits, not all bed fires can be prevented. However, identifying causative factors and crafting an appropriate response improves resident safety and minimizes the financial severity of any claims.

Julie A. Braun, JD, LLM, is a Chicago-based attorney and writer. She is a former chair of the American Bar Association's Medicine and Law Committee and former vice-chair of its Seniors' Law Committee. She chairs the legal subcommittee of a national task force considering bed safety in nursing homes, hospitals, and home healthcare environments. Braun is admitted to, among other bars, the Supreme Court of the United States.

Mark E. Bruley, BS, is a biomedical engineer and Vice-President for Accident and Forensic Investigation at ECRI in Philadelphia. ECRI is an independent, nonprofit health services research agency focusing on healthcare technology, risk management, and accident investigation. During his 31 years at ECRI, he has been responsible for clinical and laboratory evaluations of medical devices, ECRI's medical device problem reporting program, and developing ECRI's international health technology accident and forensic investigation. His investigations have included many electric bed accidents, including fires, and he has been an active participant in the FDA-initiated Hospital Bed Safety Workgroup. He assisted the FDA in drafting its 2003 safety notification on bed fires.

For further information, phone [phone]. To send your comments to the authors and editors, e-mail [e-mail].

BY JULIE A. BRAUN, JD, LLM, AND MARK E. BRULEY, BS