The U.S. Food and Drug Administration (FDA) is warning providers and facility administrators about fires caused by lithium batteries in battery-powered mobile medical carts.
 
The FDA has received reports of hospital fires and other health hazards, including explosions, fires, smoking, or overheating of equipment that required hospital evacuations, that were associated with batteries used in mobile medical carts and their chargers, according to a Dec. 27, 2016, letter on the agency's website.
 
The FDA recommends that providers inspect batteries for signs of damage, including bulging, swelling, or cracks; notify the manufacturer of damaged batteries; inspect battery chargers and carts containing chargers for overheating components; and vacuum to remove dust and lint around battery chargers and carts containing chargers.
 
The problem is limited to battery-powered mobile medical carts including crash carts, medication dispensing carts, and carts that carry and power medical devices for point of care, barcode scanners, and patient monitoring. These carts typically have high capacity lithium or lead acid batteries that can power medical devices and workstations (computers) for many hours.
 
The FDA regulates medical carts that meet the definition of a device under section 201(h) of the Federal Food, Drug and Cosmetic Act. In some cases, the battery-powered cart itself has a therapeutic function (e.g., medication dispensing carts). In other cases, the cart can function as an accessory to medical devices, such as colonoscopes, ultrasound machines, and anesthesia machines.
 
The FDA warns that lithium battery fires are very difficult to extinguish. In several reports, firefighters had to bury mobile medical cart batteries to extinguish a fire.
 
The FDA recommends that health care professionals and health care facilities take the following steps to help reduce the potential for injury to patients, staff and visitors.

Preventative Maintenance of Battery-Powered Mobile Medical Carts

• Inspect batteries for signs of damage, including bulging, swelling, or cracks.
• Notify the manufacturer of damaged batteries.
• Inspect battery chargers and carts containing chargers for overheating components.
• Vacuum to remove dust and lint around battery chargers and carts containing chargers.
• Do not use batteries that do not charge properly. Ensure that batteries are replaced at the manufacturer recommended replacement intervals.
• Conduct a survey of battery charger locations, and verify that all chargers are located in easily visible, fire retardant locations away from patient care areas and open sources of oxygen.
• Do not install chargers or charging carts in confined spaces.
• Keep flammable and explosive objects away from battery chargers and charging carts.
• Request preventative maintenance documentation from the cart manufacturer for the health care facility to use.

In its letter, the FDA recommends that healthcare facilities take the following steps if a battery in a mobile medical cart catches fire while charging or in use:

• Immediately report the fire according to your hospital protocol. Follow hospital protocol for addressing a Class C electrical fire.
• Do not touch the battery.
• Unplug the charger or power off the cart if it is safe to do so.
• Remove the cart from patient and visitor areas, as safely as possible.
• General Recommendations for Battery-Powered Mobile Medical Carts:
• Do not block any charging station vents.
• Do not tape or attach any object or material to a battery charger.
• Only operate and store the battery charger and cart with charger outside of patient rooms and in non-patient care areas.
• Contact the manufacturer if there is a problem with any component of this system. This alerts the manufacturer of a potential product concern.
• Request maintenance and user manuals for the carts, chargers, batteries, and all accessories.

The FDA recommends healthcare facilities ensure that carts meets battery standards for use in a hospital environment, and receive both preventative and maintenance documents for the carts before purchasing them.
 
Problems with mobile medical carts can be reported through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Institutions are advised to provide the FDA with the following information, if available:

• How was the cart or battery charger was being used at the time of the event
• Any patient, staff, or visitor injuries and or any actions taken by the facility
• The specific type of event that occurred (explosion, fire, smoke, etc.)
• Any cart identifiers (manufacturer name, model number)
• Any action taken by the cart system manufacturer and the reporting healthcare facility.