Recommendations to Reduce Surgical Fires and Patient Injury

Surgical fires pose a risk to both clinicians and patients and can be catastrophic, resulting in patient burns and other serious injuries, disfigurement, and death. To address this issue, the US Food and Drug Administration (FDA) recently released a safety communication reviewing factors that contribute to surgical fires and recommending practices to prevent the occurrence of such fires. The communication is specifically addressed to all healthcare professionals involved in surgical procedures. Medscape spoke with Lila Bahadori, MD, a pulmonologist and critical care physician at the FDA, about this recent safety communication.

Lila Bahadori, MD

Medscape: Could you describe the epidemiology and prevalence of surgical fires, including the types of injuries?

Bahadori: Surgical fires are well known to occur in the operating room. Most fires are related to head, neck, tracheal, and upper chest surgeries and procedures. Some of these events can be very serious and cause permanent disfigurement to a patient.

Some surgical fires are reported to the FDA and others are reported to the Emergency Care Research Institute (ECRI). Although serious injuries and deaths where a medical device reasonably caused or contributed to the event should be reported to the FDA (directly for deaths, and through the manufacturer of the device for serious injuries), the reality is that these incidents are not always reported. The figure of 550-650 surgical fires per year that is sometimes referred to was extrapolated from 2007 data from ECRI's Pennsylvania Patient Safety Reporting System.^[1,2]Recent ECRI data from 2017 report an average of 88-105 surgical fires per year in the United States, a decrease in fires from 10 years ago.^[3] These numbers have decreased, benefiting from ongoing educational efforts; however, there is often underreporting and there is a risk for resurgence of this problem secondary to a lack of adequate awareness.

The Fire Triangle

Medscape: Can you briefly explain the concept of a "fire triangle" and the factors in each of these three elements that increase risk? How does awareness of this concept help with recognition of risk?

Bahadori: The fire triangle is important. In most cases, all three elements that comprise the triangle—an oxidizing agent, an ignition source, and a fuel source—must be present for a fire to occur. In the surgical setting, oxygen and nitrous oxide are common oxidizing agents. Ignition sources include such surgical devices as electrosurgical units, electrocautery devices, lasers, and fiber-optic illumination systems. Fuel sources—a very important part of the fire triangle—include the patient's tissue, hair, skin, and intestinal gas. Other fuel sources are surgical drapes and alcohol-based skin preparations.

The presence of all three elements of the fire triangle increases the risk for surgical fire. All hospital staff, especially those in the operating room, must understand and recognize these three elements and perform a risk assessment prior to a patient's surgical procedure.