Revised Fire Hazard Rulings

The HICPAC/SHEA/APIC/IDSA Guideline for Hand Hygiene in Healthcare, published in October 2002, recommended frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers (HCWs). Shortly after the guideline was released, healthcare facilities in several states began to report that local fire marshals considered placement of alcohol-based hand rub dispensers in hallways a potential fire hazard. Based on interpretation of local or regional fire codes, some fire marshals demanded that dispensers located in hallways that serve as egress corridors be removed. In response to concerns of potential fire hazards posed by having dispensers in hallways, AHA, CDC, Joint Commission and CMS issued advisory statements recommending that healthcare facilities NOT install alcohol-based hand rub dispensers in egress corridors.

In May 2003, an on-line survey of members of the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC) and the Emerging Infections Network (EIN) was conducted to obtain further data on this issue.

Survey results, which were published in Infect Control Hosp Epidemiol 2003;24:618, revealed that 766 responding facilities had accrued an estimated combined total of 1,430 years of use of alcohol-based hand rubs without a fire attributed to or involving a dispenser

Because of the importance of making alcohol hand rubs readily accessible to healthcare workers, the AHA, CDC, American Society of Healthcare Engineers and members of the Association for Professionals in Infection Control and Epidemiology worked together with Joint Commission, the Centers for Medicare & Medicaid Services (CMS) and the National Fire Protection Association (NFPA) to address these concerns.

Revised recommendations by CMS, NFPA, and the Joint Commission allow healthcare facilities to place alcohol-based hand rub dispensers in egress corridors. The Joint Commission's recommendations on the use of ABHR, as published in the March 2006 issue of Joint Commission Perspectives, are listed below.

The Joint Commission allows ABHR gel dispensers in corridors provided that the following conditions are met:

• The corridor width is 6 feet or greater and dispensers are at least 4 feet apart.
• The dispensers are not installed over or directly adjacent to an ignition source such as an electrical outlet or switch. Adjacent is defined as being at least 6 inches from the center of the dispenser to an ignition source.
• In locations with carpeted floor coverings, dispensers installed directly over carpeted surfaces are permitted only in sprinklered smoke compartments.

Permissible volumes of an ABHR gel are as follows:

• Each smoke compartment may contain a maximum aggregate of 10 gallons (37.8 liters) of ABHR gel in dispensers and a maximum of 5 gallons (18.9 liters) in storage.
• The maximum individual dispenser fluid capacity is 0.3 gallons (1.2 liters) for dispensers in rooms, corridors, and areas open to corridors.
• The maximum dispenser size for individual dispensers in areas designated as suites of rooms is 0.5 gallons (2.O liters).

ABHR Foam: Permissible Location and Volume

Industry experts have indicated that small-quantity ABHR foam dispensers may be equivalent to ABHR gel. Therefore, pending further review, the Joint Commission will allow any ABHR foam installation that meets the location criteria stated above for ABHR gel. Volumes of ABHR foam are based on suppliers' recommendations and in no case exceed the permissible volumes for ABHR gel as defined above. In the event that subsequent testing demonstrates a safety concern relating to foam dispensers in egress corridors, the Joint Commission reserves the right to modify its position on the acceptability of such installations. In that event, previously installed dispensers would be subject to the newer restrictions; that is, they would not be "grandfathered," and noncompliant installations would have to be removed.

.