Background A variety tools are used by hospitals to evaluate their culture of safety. Although a rare occurrence, surgical fires occur as a result of breakdowns in the safety culture. Causes of these fires are related to lack of communication; lack of formal education related to surgical fires; and not adhering to advisories from professional societies and regulatory agencies. Theoretically, surgical fire prevention could be an ideal measure of safety for the following: No debate exists that fires are “never events”; the occurrence can realistically approach zero; prevention is based upon education and team communication; prevention is multi-disciplinary; and effective measures are cost-free.

Methods A survey was sent to 120 healthcare facilities across the US. 82 (68.3%) surveys were answered electronically. The results were subsequently analysed using multivariate linear regression.

Results The strongest correlation was to linking the question regarding use of fire risk assessment and planning pre-procedure to perceptions of safety, 79 respondents answered positively and 62 of these also answered a positive or strongly positive response to questions regarding safety culture (p=<0.001). All those who rated their facility indicating a poor safety culture did not experience fire prevention education and also included the 3 facilities who never evaluate OR fire risk.

Conclusions This survey suggested a correlation between the perception of a safe culture and surgical fire education and risk assessment. We realise that questionnaire return rate could skew the conclusions of this survey and analysis. Further evaluation should be pursued to ascertain if surgical fire prevention education improves the culture of safety or if facilities with an emphasis placed on safety educate their staff on surgical fire prevention. In either case, surgical fire prevention seems to be a preliminary marker for safety culture in surgical facilities.