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Operating Room Fires and Surgical Skin Preparation
Edward L Jones1, Douglas M Overbey, Brandon C Chapman
1Department of Surgery, Denver VA Medical Center and the University of Colorado, Denver, CO.
Journal of the American College of Surgeons
|February 13, 2017
Summary
Operating room fires can be caused by alcohol-based skin preparations. Using non-alcohol preparations or avoiding pooling significantly reduces fire risk during electrosurgery with oxygen.
Area of Science:
- Medical Safety
- Surgical Fire Prevention
- Biomedical Engineering
Background:
- Operating room fires are serious complications, often linked to surgical skin preparations, electrosurgery, and oxygen use.
- Data on the incidence of surgical fires related to skin preparations are limited.
- Alcohol-based preparations are commonly used in surgical settings.
Purpose of the Study:
- To evaluate the fire risk associated with different surgical skin preparations.
- To determine the impact of drying time and pooling on fire incidence.
- To compare alcohol-based versus non-alcohol-based skin preparations.
Main Methods:
- An ex vivo model using porcine skin was developed.
- Electrosurgical pencil activation (30W coagulation) was performed on skin prepped with alcohol-based solutions (70% IPA, 74% IPA with iodine, 70% IPA with 2% CHG) and non-alcohol solutions.
- Tests were conducted immediately and 3 minutes post-application, with and without pooling, in 21% oxygen.
Main Results:
- No fires occurred with non-alcohol-based preparations.
- Alcohol-based preparations ignited in 22% of tests at 0 minutes and 10% at 3 minutes.
- Pooling of alcohol-based preparations increased fire incidence to 38% at 0 minutes and 27% at 3 minutes.
Conclusions:
- Alcohol-based skin preparations are a significant fire hazard in operating rooms.
- Even after 3 minutes of drying, alcohol-based preparations can cause fires, especially with pooling.
- Using non-alcohol-based preparations or preventing pooling are key strategies to reduce surgical fire risk.
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