Surgical fires, though rare, pose a significant risk to patient safety during procedures. These fires can disrupt surgical care, cause injuries to patients, extend hospital stays, and increase healthcare costs. They are also linked to significant litigation 1. Understanding their risk factors and implementing effective prevention strategies is crucial for healthcare professionals to mitigate this hazard.

The primary components necessary for a surgical fire are an oxidizer, an ignition source, and a fuel. This “fire triangle” must be present for a fire to occur in the operating room (OR) 2. Oxygen and nitrous oxide are common oxidizers used in surgeries. Elevated levels of oxygen, especially in enclosed surgical areas like the airway, can significantly increase the risk of fire.

Potential ignition sources include electrosurgical units (ESUs), lasers, fiber optic light sources, and high-speed drills. The use of these devices during a procedure increases the risk of surgical fires. These devices generate heat that can ignite surgical drapes, alcohol-based skin preparations, and other flammable materials in the OR.

Common fuels in the OR include surgical drapes, gowns, alcohol-based antiseptics, and the patient’s tissues. Even seemingly non-flammable items can become fuel sources when in contact with high oxygen levels and ignition sources 3.

Preventing surgical fires requires a multifaceted approach involving awareness, training, and the implementation of safety protocols 3. First, proper management of the OR environment is essential for reducing the risk of surgical fires. This includes reducing oxygen concentration in the surgical field when possible. Additionally, allowing adequate drying time for alcohol-based skin preparations before initiating surgery can prevent ignition.

Second, ensuring that all equipment is in good working condition and used according to manufacturer instructions is critical. Regular maintenance and inspection of devices that can act as ignition sources, such as ESUs and lasers, help minimize the risk. Using spark arrestors and non-conductive materials around ignition sources can further enhance safety.

Third, all OR personnel should be trained in fire safety and prevention. This includes understanding the fire triangle, recognizing potential hazards, and knowing how to respond in case of a fire. Effective communication among surgical team members is vital. Conducting preoperative briefings to discuss fire risks and prevention measures can enhance team preparedness.

Finally, using fire-retardant drapes and gowns can reduce the risk of fuel ignition. Additionally, choosing non-flammable antiseptic solutions when possible can mitigate one of the common sources of surgical fires 4.

Despite best efforts, fires can still occur. Having a well-defined fire response plan is crucial. This plan should include immediate actions to extinguish the fire, protect the patient, and evacuate if necessary. Regular fire drills can ensure that all team members are familiar with the procedures and can act swiftly in an emergency 5,6.

While rare, surgical fires do represent a serious risk in the operating room. Understanding the contributing factors and implementing comprehensive prevention strategies enables healthcare professionals to reduce the incidence of these potentially devastating events. Continuous education, stringent safety protocols, and effective team communication are the cornerstones of surgical fire prevention, ensuring patient safety and the quality of surgical care.

References

1. Stormont, G., Anand, S. & Deibert, C. M. Surgical Fire Safety. StatPearls (2023).
2. AANA | Surgical Fires. Available at: https://www.aana.com/practice/clinical-practice/clinical-practice-resources/surgical-fires/. (Accessed: 7th June 2024)
3. Jones, T. S., Black, I. H., Robinson, T. N. & Jones, E. L. Operating Room Fires. Anesthesiology 130, 492–501 (2019). doi: 10.1097/ALN.0000000000002598
4. Surgical Fires – OpenAnesthesia. Available at: https://www.openanesthesia.org/keywords/surgical-fires/. (Accessed: 7th June 2024)
5. Hart, S. R., Yajnik, A., Ashford, J., Springer, R. & Harvey, S. Operating Room Fire Safety. Ochsner J. 11, 37 (2011).
6. Mai, C. L. et al. Prevention and Management of Operating Room Fire: An Interprofessional Operating Room Team Simulation Case. MedEdPORTAL 16, 10871 (2020). doi: 10.15766/mep_2374-8265.10871