Recommendations to Reduce Surgical Fires and Patient Injury

Ignition Sources and Fire Risk

Medscape: As we discussed, the fire triangle includes three elements: oxidizer, ignition source, and fuel source. We just covered the oxidizer. What are the commonly used pieces of equipment that can serve as an ignition source, and how can risk with their use be mitigated?

Bahadori: The main ignition sources are electrosurgical, electrocautery, and laser units. These devices can cause different types of injuries, including direct burns to the patient; they can also cause surgical fires.

An important precaution is to make sure these devices are in standby mode and placed in holsters or turned off when they are not in use.

Other precautions include ensuring that all surgical devices are in good working condition. For example, there should be no connection issues or frayed wires, and the tips of the cautery instruments should be clean. In addition, the surgical team should avoid placing catheter sleeves over electrosurgical and electrical units.

Equipment should always be handled and used correctly. Again, all three elements of the fire triangle must be present for a fire to occur, and the equipment is a potential ignition source. Therefore, when not in use, these units should be placed in standby mode or turned off, and should never be in close proximity to an oxidizing source such as oxygen.

Medscape: Regarding the fuel source, you mentioned surgical drapes and the patient's tissue and hair. Are there other items that could serve as potential fuel sources?

Bahadori: Surgical drapes, which are not fire retardant, are a big potential fuel source. The surgical team often forgets that patients are also a fuel source; this includes tissue and hair. Even intestinal gases can ignite, particularly during colorectal surgery or colonoscopy—especially when a cautery device is used.

If alcohol preps are used, the team must ensure that these are completely dry before starting the procedure.

Medscape: For the external agents, are there any alternative products that can be used to reduce the risk for surgical fire?

Bahadori: There are no fire-retardant products, but there are recommendations to reduce risk. One recommendation is not to have fenestrated products in the operating room because they can collect oxygen.